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Individual

PAUL C. DEFFELY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LMFT

Contact information

Practice address
530 N MAIN ST, PROVIDENCE, RI 02904-5762
(401) 274-2500
Mailing address
528 N MAIN ST, PROVIDENCE, RI 02904-5757

Taxonomy

Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
MFT00050
RI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1104847946
THE PROVIDENCE CENTER NPI
RI
01
30020-5
BLUE CROSS
RI
01
408911
BLUE CHIP
RI
01
62-56969
UNITED BEHAVIORAL HEALTH
RI
05
PD41386
RI
Enumeration date
07/20/2006
Last updated
03/27/2009
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