1457304719 NPI number — COLLEEN GORMAN JUDGE LMHC

Table of content: COLLEEN GORMAN JUDGE LMHC (NPI 1457304719)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457304719 NPI number — COLLEEN GORMAN JUDGE LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JUDGE
Provider First Name:
COLLEEN
Provider Middle Name:
GORMAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457304719
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
46 BARNES ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02828-2025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-949-9868
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33 COLLEGE HILL RD
Provider Second Line Business Practice Location Address:
SUITE 30E
Provider Business Practice Location Address City Name:
WARWICK
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02886-2776
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-821-6070
Provider Business Practice Location Address Fax Number:
401-821-6047
Provider Enumeration Date:
05/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MHC00127 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30240-5 . This is a "BC/BS OF RI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2083869 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 409065 . This is a "BLUECHIP" identifier . This identifiers is of the category "OTHER".