Provider Demographics
NPI:1801430509
Name:CONCENTRIC PSYCHOLOGICAL SERVICES PC
Entity type:Organization
Organization Name:CONCENTRIC PSYCHOLOGICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:MARTINO-HARMS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:401-425-0707
Mailing Address - Street 1:205 WATERMAN ST STE 106
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4313
Mailing Address - Country:US
Mailing Address - Phone:401-425-0707
Mailing Address - Fax:401-735-1666
Practice Address - Street 1:205 WATERMAN ST STE 106
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4313
Practice Address - Country:US
Practice Address - Phone:401-425-0707
Practice Address - Fax:401-735-1666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty