Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | PS00239 | RI |
NPI | 1043416332 |
---|---|
Provider Name | Dr. Gerald P Champagne |
First Address | East Greenwich, RI 02818-3833 |
Second Address | East Greenwich, RI 02818-3833 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2007 |
Last Update Date | 08/07/2007 |