Provider Demographics
NPI:1245695964
Name:PETITPAS PSYCHIATRIC SERVICES, LLC
Entity type:Organization
Organization Name:PETITPAS PSYCHIATRIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PETITPAS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN/PCNS
Authorized Official - Phone:401-944-0194
Mailing Address - Street 1:900 RESERVOIR AVE
Mailing Address - Street 2:STE.2
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-4453
Mailing Address - Country:US
Mailing Address - Phone:401-944-0194
Mailing Address - Fax:401-944-0196
Practice Address - Street 1:900 RESERVOIR AVE
Practice Address - Street 2:STE.2
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-4453
Practice Address - Country:US
Practice Address - Phone:401-944-0194
Practice Address - Fax:401-944-0196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPCNS00064364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI413965OtherRI BLUE CHIP PROVIDER #
RI0000032309OtherRI BLUE CROSS PROVIDER #
RI6228710OtherUNITED HEALTH PROVIDER #