Basic Information
| Provider Information | |||||||||
| NPI: | 1801954847 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BELANGER | ||||||||
| FirstName: | TERRI | ||||||||
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| Credential: | PCNS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 48 TURNER DR | ||||||||
| Address2: | |||||||||
| City: | WEST WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028935428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013311350 | ||||||||
| FaxNumber: | 4012773366 | ||||||||
| Practice Location | |||||||||
| Address1: | 345 BLACKSTONE BLVD | ||||||||
| Address2: | ANNEX BLDG, RM 232 | ||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029064800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003703651 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2006 | ||||||||
| LastUpdateDate: | 08/27/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN25557 | RI | N | Nursing Service Providers | Registered Nurse | 163WP0808X | PPNS00063 | RI | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 364SP0809X | PPNS00063 | RI | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Adult |
ID Information
| ID | Type | State | Issuer | Description | 29111-6 | 01 | RI | BLUE CROSS | OTHER | 12378202 | 01 | MULTI-PLAN | OTHER | 412625 | 01 | RI | BLUE CHIP | OTHER | 62-46938 | 01 | UNITED BEHAVIROAL HEALTH | OTHER | TB06857 | 05 | RI | MEDICAID | 1021740 | 01 | NHP-GROUP NUMBER | OTHER |