Provider Demographics
NPI:1720243157
Name:THE CENTER FOR LEARNING AND PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:THE CENTER FOR LEARNING AND PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:401-683-7600
Mailing Address - Street 1:107 CLOCK TOWER SQ
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-1396
Mailing Address - Country:US
Mailing Address - Phone:401-683-7600
Mailing Address - Fax:
Practice Address - Street 1:107 CLOCK TOWER SQ
Practice Address - Street 2:SUITE 107
Practice Address - City:PORTSMOUTH
Practice Address - State:RI
Practice Address - Zip Code:02871-1396
Practice Address - Country:US
Practice Address - Phone:401-683-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00919103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIHB65804Medicaid
689004854Medicare UPIN