Provider Demographics
NPI:1447297387
Name:BORDEN, MICHAEL CHRISTOPHER (PHD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CHRISTOPHER
Last Name:BORDEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:C
Other - Middle Name:MICHAEL
Other - Last Name:BORDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1011 VETERANS MEMORIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-5061
Mailing Address - Country:US
Mailing Address - Phone:401-432-1175
Mailing Address - Fax:401-432-1509
Practice Address - Street 1:1011 VETERANS MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02915-5061
Practice Address - Country:US
Practice Address - Phone:401-432-1175
Practice Address - Fax:401-432-1509
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00473103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI30169-5OtherBLUE CROSS
RI407746OtherBLUE CHIP
RI61-15754OtherUNITED BEHAVIORAL HEALTH
RIMB10785Medicaid