Provider Demographics
NPI:1720444193
Name:QUETZAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:QUETZAL ASSOCIATES, INC.
Other - Org Name:KRISTIE PUSTER, PH.D. AND JOSEPH BERRYHILL, PH.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:401-903-2413
Mailing Address - Street 1:21 CARPENTER AVE
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-2005
Mailing Address - Country:US
Mailing Address - Phone:401-903-2413
Mailing Address - Fax:401-289-0297
Practice Address - Street 1:1445 WAMPANOAG TRL
Practice Address - Street 2:SUITE 106
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-1000
Practice Address - Country:US
Practice Address - Phone:401-903-2413
Practice Address - Fax:401-289-0297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS01332103T00000X
RIPSO1360103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty