Organization
PHOENIX HOUSES OF NEW ENGLAND, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PETER MUMMA (PRESIDENT/ CEO)
(401) 331-4250
Entity
Organization
Contact information
Practice address
99 WAYLAND AVE, SUITE 100, PROVIDENCE, RI 02906-4314
(401) 331-4250
(401) 421-5520
Mailing address
99 WAYLAND AVE, SUITE 100, PROVIDENCE, RI 02906-4314
(401) 331-4250
(401) 421-5520
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
207QA0401X
Addiction Medicine (Family Medicine) Physician
—
—
2084P0800X
Psychiatry Physician
—
—
2084P0802X
Addiction Psychiatry Physician
—
—
324500000X
Substance Abuse Rehabilitation Facility
02725
NH
324500000X
Substance Abuse Rehabilitation Facility
0296
MA
324500000X
Substance Abuse Rehabilitation Facility
621
RI
324500000X
Substance Abuse Rehabilitation Facility
Primary
CMC 00028
RI
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1002232
—
VT
05
—
1006554
—
VT
05
—
1009358
—
VT
05
—
1009585
—
VT
01
—
15601000
MAINECARE
ME
01
—
15601001
MAINECARE
ME
01
—
203388
BC RI
—
05
—
30007117
—
NH
01
—
30763
BC RI
—
01
—
30766
BC RI
—
01
—
410875
BC RI
—
01
—
410878
BC RI
—
01
—
467656
MOHEGAN SUN VALUE OPTIONS
—
01
—
6988
BC RI
—
01
—
9192
NHP RI
RI
01
—
9202
NHP RI
RI
01
—
9203
NHP RI
RI
01
—
9515
NHP RI
RI
05
—
MA04867
—
RI
Enumeration date
11/03/2006
Last updated
04/09/2021
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