Individual
DR. GRAHAM C. JELLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D
Contact information
Practice address
172 E CUSHING ST, PROVIDENCE, RI 02906-2255
(401) 273-7736
(401) 273-7736
Mailing address
172 E CUSHING ST, PROVIDENCE, RI 02906-2255
(401) 273-7736
(401) 273-7736
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS00381
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
35673
BCBS OF RI
RI
05
—
GJ57242
—
RI
01
—
R002968
CHAMPUS
RI
Enumeration date
03/08/2007
Last updated
07/08/2007
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