Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 1017865 | MA |
N | 103T00000X | Psychologist | 1017865 | MA |
Y | 102L00000X | Psychologist | ISWOO425 | RI |
Y | 103T00000X | Psychologist | ISWOO425 | RI |
NPI | 1003924226 |
---|---|
Provider Name | Mrs. Gladys V Rezendes |
First Address | Providence, RI 02907 |
Second Address | Providence, RI 02907 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2006 |
Last Update Date | 08/07/2007 |