NPI 1457549578
Nickerson Community Center
Practice location
- Address
- 97 Delaine St, Providence, RI 02909-2726
- Phone
- (401) 383-5672
- Mailing address
- 133 Delaine St, Providence, RI 02909-2728
Authorised official
- Name
- Lisa D'Ambra
- Title
- Executive Director
- Phone
- (401) 351-2241
Registered specialties (2)
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
Community/Behavioral Health Agency
Registry record
- NPI
- 1457549578
- Entity type
- Organization
- NPI issued
- 15 Oct 2007
- Record last updated
- 15 Oct 2007
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.