PHOENIX HEALTH PROFESSIONAL GROUP, LLC (NPI# 1063037364) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063037364 |
| Entity Type | Organization |
| Organization Name | PHOENIX HEALTH PROFESSIONAL GROUP, LLC |
| Practice Address |
99 Wayland Ave Ste 100 Providence RI 02906-4314 |
| Mailing Address |
1301 Atwood Ave Ste 100 Johnston RI 02919-4933 |
| Practice Telephone | 6177711154 |
| Mailing Telephone | 6177711154 |
| Enumeration Date | 2020-06-11 |
| Last Update Date | 2020-06-11 |
| Authorized Official Name | JOEL K GOLOSKIE (COUNSEL) |
| Authorized Official Telephone | 6177711154 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163WA0400X |
Registered Nurse Specialization: Addiction (Substance Use Disorder) |
Nursing Service Providers | ||
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers | ||
| N | 104100000X | Social Worker | Behavioral Health & Social Service Providers | ||
| Y | 103TA0400X |
Psychologist Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers |
| Other Name | Type Code |
|---|---|
| Phoenix Health | Doing Business As Name - Organization |
| Street Address |
99 WAYLAND AVE STE 100 |
| City | PROVIDENCE |
| State | RI |
| Zip Code | 02906-4314 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285245175 | Birdsong Traditional Medicine, LLC | Acupuncturist | 148 Waterman St. Ground Level, Providence, RI 02906 | 2020-08-13 |
| 1881218071 | Madison Pomerantz | Psychiatry & Neurology | 345 Blackstone Boulevard, Box G-bh, Providence, RI 02906 | 2020-06-03 |
| 1316453855 | Ellen Van Ingen Darling | Psychologist | 285 Governor St Ste 250, Providence, RI 02906 | 2017-12-20 |
| 1275063919 | Marissa Martz | Psychiatry & Neurology | 345 Blackstone Blvd., Providence, RI 02906 | 2017-06-15 |
| 1235663220 | Alena Haltzman | Counselor | 223 Summit Ave, Providence, RI 02906 | 2017-04-17 |
| 1669823399 | Kathryn Fleming-ives LLC | Psychiatry & Neurology | 355 Hope St Unit 1, Providence, RI 02906 | 2016-06-23 |
| 1134573389 | Sarah E. Kramer | Psychiatry & Neurology | Butler Hospital, Adult Psychiatry Residency, 345 Blackstone Blvd, Providence, RI 02906 | 2016-04-13 |
| 1538534201 | Laura Anne Buss | Social Worker | 55 Hope St., Providence, RI 02906 | 2015-12-07 |
| 1700289360 | Tinatin Surguladze | Counselor | 205 Waterman St Suite 106, Providence, RI 02906 | 2014-09-26 |
| 1467851519 | Jamila Allouane | Social Worker | 120 Wayland Avenue Suite 2, Providence, RI 02906 | 2014-08-14 |
| Find all providers in zip 02906 | ||||
| Taxonomy Code | 103TA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346647450 | Kate Carey | Psychologist | Po Box G-s121, Brown University School of Public Health, Providence, RI 02912-0001 | 2014-12-04 |
| 1033675145 | Mark A Celio | Psychologist | 121 S Main St, Providence, RI 02903-2905 | 2019-02-13 |
| 1205000544 | Ana Maria Abrantes | Psychologist | 345 Blackstone Blvd, Providence, RI 02906-4800 | 2008-04-17 |
| 1518181593 | Peter M Monti | Psychologist | 830 Chalkstone Ave, Providence, RI 02908-4734 | 2007-04-12 |
| 1053324483 | John Elliott Mcgeary | Psychologist | 830 Chalkstone Ave, Providence, RI 02908-4734 | 2006-08-15 |
| 1417911207 | Maureen Harkavy | Psychologist | 825 Chalkstone Ave, Providence, RI 02908-4728 | 2006-04-17 |
| 1386620466 | Henry R Lesieur | Psychologist | 593 Eddy St, Apc 970, Providence, RI 02903-4923 | 2005-12-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962409649 | Gregg M Etter | Psychologist | 2756 Post Rd, Warwick, RI 02886-3003 | 2005-07-07 |
| 1740294941 | William H Norman | Psychologist | 580 Ten Rod Rd, North Kingstown, RI 02852-4220 | 2006-07-27 |
| City | PROVIDENCE |
| Zip Code | 02906 |
Please comment or provide details below to improve the information on PHOENIX HEALTH PROFESSIONAL GROUP, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.