Provider Demographics
NPI:1669417077
Name:ASHWORTH, JUDITH (PCNS)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:ASHWORTH
Suffix:
Gender:F
Credentials:PCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 COLLEGE HILL RD
Mailing Address - Street 2:BLDG 29
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2776
Mailing Address - Country:US
Mailing Address - Phone:401-822-4673
Mailing Address - Fax:401-822-4676
Practice Address - Street 1:33 COLLEGE HILL RD
Practice Address - Street 2:BLDG 29
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2776
Practice Address - Country:US
Practice Address - Phone:401-822-4673
Practice Address - Fax:401-822-4676
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN14141163WP0808X
RIAPRN00187364SP0809X
RICAPRN00187364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIBLK31OtherGIC
RI410930OtherBLUE CROSS OF IL
RI26721-4OtherBLUECROSS & BLUE SHIELD
RI05-0468084OtherUNITED HEALTH PLANS
RI410930OtherCOORDINATED HEALTH PLANS