Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PS00773 | RI |
N | 103TC0700X | Clinical Psychologist | PS00773 | RI |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PS00773 | RI |
NPI | 1053471763 |
---|---|
Provider Name | Dr. Regina Leigh Kuecks-Morgan |
First Address | Providence, RI 02906-2411 |
Second Address | Providence, RI 02906-2119 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1040290 | BEACON NEIGHBORHOOD HEALT (01) | RI |
210158 | UNITED BEHAVIORAL HEALTH (01) | RI |
26429-5 | BLUE CROSS BLUE SHIELD (01) | RI |
RK56885 | (05) | RI |