1306890546 NPI number — PLAZA PSYCHOLOGY & PSYCHIATRY, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306890546 NPI number — PLAZA PSYCHOLOGY & PSYCHIATRY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLAZA PSYCHOLOGY & PSYCHIATRY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1306890546
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
68 CUMBERLAND ST
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
WOONSOCKET
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02895-3323
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-356-1940
Provider Business Mailing Address Fax Number:
401-356-1949

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
68 CUMBERLAND ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
WOONSOCKET
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02895-3323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-356-1940
Provider Business Practice Location Address Fax Number:
401-356-1949
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
YANNI
Authorized Official First Name:
PENELOPE
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
401-356-1940

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1028940 . This is a "BEACON" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 1306890546 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 1306890546 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: PP44291 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9427305 . This is a "AETNA" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 1028940 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 360121 . This is a "TUFT'S" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: PP54298 . This is a "RITE SHARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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