Individual
JACOB LUKE VARELA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
345 BLACKSTONE BLVD STE 2, PROVIDENCE, RI 02906-4829
(844) 401-0111
Mailing address
455 TOLL GATE RD, PRC AND CREDENTIALING, WARWICK, RI 02886-2759
(401) 273-0641
(401) 273-2919
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PS02308
RI
Other
Enumeration date
01/08/2025
Last updated
06/17/2025
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