# ROGER WILLIAMS MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ROGER WILLIAMS ADDICTION MEDICINE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457395998
- **Authorized official:** KENNETH BELCHER (PRESIDENT, CEO)
- **Authorized official phone:** (401) 456-2025

## Contact information

- **Practice address:** 825 CHALKSTONE AVE, PROVIDENCE, RI 02908-4728
- **Practice address phone:** (401) 456-2363
- **Practice address fax:** (401) 456-6744
- **Mailing address:** 825 CHALKSTONE AVE, PROVIDENCE, RI 02908-4728
- **Mailing address phone:** (401) 456-2525
- **Mailing address fax:** (401) 456-6742

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TA0400X | Addiction (Substance Use Disorder) Psychologist | HOS00108 | RI | — |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | NULL | Yes |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | — | Yes |
| 2084P0802X | Addiction Psychiatry Physician | HOS00108 | RI | — |

## Other

- **Enumeration date:** 06/15/2006
- **Last updated:** 03/13/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | RW18813 | — | RI |