Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | DO00603 | RI |
NPI | 1417911207 |
---|---|
Provider Name | Maureen Harkavy |
First Address | North Providence, RI 02904-5113 |
Second Address | Providence, RI 02908-4728 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 09/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31150-0 | BLUE CROSS OF RI (01) | RI |
413238 | BLUE CHIP OF RI (01) | RI |
7058234 | (05) | RI |
G32329 | (02) | RI |