Home Port Therapy

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

License

MFT00100 Issued in RI

Legal business name

HOME PORT THERAPY

Practice address

23 North Rd Ste A25
Peace Dale, RI 02879-2176

Phone

(401) 932-1181

Fax

(401) 783-1154

NPI assigned

Nov 6, 2007

Last updated

Nov 6, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Reynard Bullock, MS LMFT

Title

Owner

Phone

(401) 932-1181

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1194307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194307200000",
    "number": "1740460872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 NORTH RD STE A25",
            "city": "PEACE DALE",
            "state": "RI",
            "postal_code": "028792176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 NORTH RD STE A25",
            "city": "PEACE DALE",
            "state": "RI",
            "postal_code": "028792176",
            "telephone_number": "401-932-1181",
            "fax_number": "401-783-1154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOME PORT THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-06",
        "last_updated": "2007-11-06",
        "status": "A",
        "authorized_official_last_name": "BULLOCK",
        "authorized_official_first_name": "REYNARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "401-932-1181",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MS LMFT"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "RI",
            "license": "MFT00100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• North Road Psychiatry LLC

• Adult Mental Health Clinic/Center in Peace Dale, RI
• Providers in Peace Dale, RI by specialty
• Adult Mental Health Clinic/Center in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.