Provider Demographics
NPI:1912598046
Name:EMDR & SOMATIC PSYCHOTHERAPIES OF RHODE ISLAND
Entity Type:Organization
Organization Name:EMDR & SOMATIC PSYCHOTHERAPIES OF RHODE ISLAND
Other - Org Name:SOUTH COUNTY MENTAL HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MADRONE
Authorized Official - Middle Name:
Authorized Official - Last Name:PHOENIX
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:401-297-0692
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02881-0005
Mailing Address - Country:US
Mailing Address - Phone:401-441-5834
Mailing Address - Fax:401-210-8248
Practice Address - Street 1:1 RICHMOND SQ STE 333C
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5139
Practice Address - Country:US
Practice Address - Phone:401-441-5834
Practice Address - Fax:401-210-8248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-01
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty