Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PS00283 | RI |
N | 103TC0700X | Clinical Psychologist | PS00283 | RI |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | PS00283 | RI |
NPI | 1003892712 |
---|---|
Provider Name | Debra J Lobato-Barrera |
First Address | Providence, RI 02903-4923 |
Second Address | Providence, RI 02903-4141 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2005 |
Last Update Date | 19/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PS00283 | PROFESSIONAL LICENSE (01) | RI |