Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 0877 | RI |
Y | 103T00000X | Psychologist | 0877 | RI |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 0877 | RI |
N | 103G00000X | Clinical Psychologist | 0877 | RI |
N | 103TC0700X | Clinical Psychologist | 0877 | RI |
N | 103TH0100X | Health Service | 0877 | RI |
NPI | 1194886051 |
---|---|
Provider Name | Deborah Sepinwall |
First Address | Providence, RI 02906-3116 |
Second Address | Providence, RI 02906-3116 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 12/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
29869-2 | BLUE CROSS PROVIDER NUMBE (01) | RI |
412845 | BLUE CHIP PROVIDER NUMBER (01) | RI |