Basic Information
Provider Information
NPI: 1366984205
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALJABARI
FirstName: RAWYA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: PHD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 117 ELLENFIELD ST
Address2: SUITE 101
City: PROVIDENCE
State: RI
PostalCode: 029054513
CountryCode: US
TelephoneNumber: 4014446779
FaxNumber: 4014446912
Practice Location
Address1: 593 EDDY ST
Address2: POTTER 2
City: PROVIDENCE
State: RI
PostalCode: 029034923
CountryCode: US
TelephoneNumber: 4014442128
FaxNumber: 4014448836
Other Information
ProviderEnumerationDate: 11/09/2016
LastUpdateDate: 12/22/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC0700XPS01597RIY Behavioral Health & Social Service ProvidersPsychologistClinical

No ID Information.


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