| Doctor Name: | DR. GERALD P CHAMPAGNE |
| NPI Number: | 1043416332 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | PS00239 |
| Business Practice Address: | 126 Peirce St East Greenwich, RI - 028183833 |
| Business Phone Number: | 4018855677 |
| Business Fax Number: | 4018860693 |
| Mailing Address: | 126 Peirce St, EAST GREENWICH |
| State: | RI |
| Postal Code: | 028183833 |
| Phone Number: | 4018855677 |
| Fax Number: | 4018860693 |
| NPI Enumeration Date: | 06/22/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC2200X |
| License Number: | PS00239 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | RI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical Child & Adolescent |
| Taxonomy Definition: | |