Organization
SOUTHCOAST PSYCHOLOGY,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS J. PETROUSKI PSY.D. (PRESIDENT)
(508) 644-1210
Entity
Organization
Contact information
Practice address
154 WATERMAN STREET, 3RD FLOOR WEST, PROVIDENCE, RI 02906
(401) 241-2059
Mailing address
P.O. BOX 642, ASSONET, MA 02702-1446
(508) 644-1210
(508) 644-1210
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS00719
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
#SS11558
—
RI
Enumeration date
05/04/2007
Last updated
08/22/2020
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