Individual
AILEEN JAMES ARCHAMBAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
220 HOWELL ST, PROVIDENCE, RI 02906-1614
(413) 347-3936
Mailing address
1000 EDDY ST, PROVIDENCE, RI 02905-4739
(401) 533-9104
(401) 533-9105
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
222Q00000X
Developmental Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0614
NHPRI
RI
05
—
EO1788
—
RI
01
—
SB870
BLUE CROSS
RI
Enumeration date
08/01/2018
Last updated
09/02/2020
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