Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 261QR0405X | Clinic/Center | Rehabilitation, Substance Use Disorder | | | No |
| 2 | 261QM0801X | Clinic/Center | Mental Health (Including Community Mental Health Center) | | | No |
| 3 | 261QM1300X | Clinic/Center | Multi-Specialty | | | No |
| 4 | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | | | | No |
| 5 | 251B00000X | Case Management | | | | No |
| 6 | 251E00000X | Home Health | | | | No |
| 7 | 251K00000X | Public Health or Welfare | | | | No |
| 8 | 251S00000X | Community/Behavioral Health | | 609.1 | RHODE ISLAND | No |
| 9 | 101YM0800X | Counselor | Mental Health | | | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | FR02382 | MEDICAID | RHODE ISLAND | |
| 2 | FR05260 | MEDICAID | RHODE ISLAND | |
| 3 | FR05437 | MEDICAID | RHODE ISLAND | |
| 4 | FR50342 | MEDICAID | RHODE ISLAND | |
| 5 | FR29830 | MEDICAID | RHODE ISLAND | |
| 6 | 2094 | OTHER | RHODE ISLAND | RITE CARE EARLY INTER |
| 7 | 29213 | OTHER | RHODE ISLAND | BCBS EARLY INTERN |
| 8 | 237628 | OTHER | RHODE ISLAND | BCBS SUB ABUSE |
| 9 | 412128 | OTHER | RHODE ISLAND | BLUE CHIP EARY INTER |
| 10 | 1021170 | OTHER | RHODE ISLAND | RITE CARE NHP |
| 11 | 7497 | OTHER | RHODE ISLAND | BLUE CHIP BLUE CROSS COUN |
| 12 | FR02385 | MEDICAID | RHODE ISLAND | |
