Provider Demographics
NPI:1538837950
Name:RALLIS, BETHANY (PHD, LCP)
Entity type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:
Last Name:RALLIS
Suffix:
Gender:F
Credentials:PHD, LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 BLUEBERRY LN
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02835-2903
Mailing Address - Country:US
Mailing Address - Phone:401-954-4283
Mailing Address - Fax:
Practice Address - Street 1:19 FRIENDSHIP STREET
Practice Address - Street 2:BORDEN-CAREY BUILDING, SUITE 340
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-2272
Practice Address - Country:US
Practice Address - Phone:401-845-1910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS01879103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical