Individual provider Active NPI

Gisela Gabriela Jimenez Colon, MS

  • Clinical Psychologist
  • Riverside, RI
National Provider Identifier
1396228961
Registry record updated Feb 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PS02047 Issued in RI
Practice address
1011 Veterans Memorial Pkwy
Riverside, RI 02915-5099
Phone
(401) 432-1119
NPI assigned
Sep 10, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 24, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X CA
Clinical Psychologist 103TC0700X PS02047 RI Primary

Addresses

Primary practice location

1011 Veterans Memorial Pkwy
Riverside, RI 02915-5099

Mailing address

1011 Veterans Memorial Pkwy
Riverside, RI 02915-5099
Phone (401) 432-1119

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220518000779 RI Practitioner - Clinical Psychologist 8123405867 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science, Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Emma Pendleton Bradley Hospital CurrentSince Jun 5, 2022 Accepting new patients
Lifespan Physician Group, Inc. CurrentSince Jun 5, 2022 Accepting new patients
Gateway Healthcare Inc CurrentSince Jun 5, 2022 Accepting new patients
Lifespan Physician Group, Inc. Clinical CurrentSince Jun 5, 2022 Accepting new patients
Emma Pendleton Bradley Hospital CurrentSince Jun 5, 2022 Accepting new patients

Locations

1516 Atwood Ave
Johnston, RI 02919
Phone (401) 463-8829

105 Bacon St
Pawtucket, RI 02860
Phone (401) 722-3560

117 Ellenfield St
Ste 101
Providence, RI 02905
Phone (401) 444-4318

1 Virginia Ave
Ste 200
Providence, RI 02905

593 Eddy St
Providence, RI 02903

1011 Veterans Memorial Pkwy
Riverside, RI 02915
Phone (401) 432-1000

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1536537600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645660800000",
    "number": "1396228961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 VETERANS MEMORIAL PKWY",
            "city": "RIVERSIDE",
            "state": "RI",
            "postal_code": "029155099",
            "telephone_number": "401-432-1119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 VETERANS MEMORIAL PKWY",
            "city": "RIVERSIDE",
            "state": "RI",
            "postal_code": "029155099",
            "telephone_number": "401-432-1119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JIMENEZ COLON",
        "first_name": "GISELA",
        "middle_name": "GABRIELA",
        "credential": "MS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-10",
        "last_updated": "2022-02-24",
        "certification_date": "2022-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "RI",
            "license": "PS02047",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, RI

Sources for this page

Verify at the official NPI Registry.