Basic Information
Provider Information
NPI: 1437179413
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RASILE
FirstName: DEBORAH
MiddleName: A
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 593 EDDY ST
Address2: GEORGE CLINIC
City: PROVIDENCE
State: RI
PostalCode: 029034923
CountryCode: US
TelephoneNumber: 4014443201
FaxNumber: 4014446115
Practice Location
Address1: 593 EDDY ST
Address2: GEORGE CLINIC
City: PROVIDENCE
State: RI
PostalCode: 029034923
CountryCode: US
TelephoneNumber: 4014443201
FaxNumber: 4014446115
Other Information
ProviderEnumerationDate: 07/20/2006
LastUpdateDate: 07/17/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC0700XPS00543RIY Behavioral Health & Social Service ProvidersPsychologistClinical

No ID Information.


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