Provider Demographics
NPI:1104713536
Name:STILL WATERS PSYCHIATRY, LLC
Entity type:Organization
Organization Name:STILL WATERS PSYCHIATRY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:251-533-1424
Mailing Address - Street 1:197 WARREN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-4826
Mailing Address - Country:US
Mailing Address - Phone:401-238-0776
Mailing Address - Fax:401-757-8688
Practice Address - Street 1:197 WARREN AVE STE 101
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-4826
Practice Address - Country:US
Practice Address - Phone:401-238-0776
Practice Address - Fax:401-757-8688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-19
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty