Provider Demographics
NPI:1801954847
Name:BELANGER, TERRI (PCNS)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:BELANGER
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 1:48 TURNER DR
Mailing Address - Street 2:
Mailing Address - City:WEST WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02893-5428
Mailing Address - Country:US
Mailing Address - Phone:401-331-1350
Mailing Address - Fax:401-277-3366
Practice Address - Street 1:345 BLACKSTONE BLVD
Practice Address - Street 2:ANNEX BLDG, RM 232
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4800
Practice Address - Country:US
Practice Address - Phone:800-370-3651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN25557163W00000X
RIPPNS00063163WP0808X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI29111-6OtherBLUE CROSS
12378202OtherMULTI-PLAN
RI412625OtherBLUE CHIP
62-46938OtherUNITED BEHAVIROAL HEALTH
RITB06857Medicaid
1021740OtherNHP-GROUP NUMBER
1021740OtherNHP-GROUP NUMBER
RI007058288Medicare PIN