1508165408 NPI number — CLINICAL ASSESSMENT AND CONSULTATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508165408 NPI number — CLINICAL ASSESSMENT AND CONSULTATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICAL ASSESSMENT AND CONSULTATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508165408
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 272
Provider Second Line Business Mailing Address:
1061 FISH ROAD
Provider Business Mailing Address City Name:
TIVERTON
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02878-0272
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-624-7281
Provider Business Mailing Address Fax Number:
401-624-7208

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 NATHAN ELLIS HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MASHPEE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02878-0272
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-624-7281
Provider Business Practice Location Address Fax Number:
401-624-7208
Provider Enumeration Date:
03/18/2011

Additional Information

Authorized Official

Authorized Official Last Name:
DUWORS
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PH.D.
Authorized Official Telephone Number:
401-624-7281

Provider Taxonomy Codes

  • Taxonomy code: 103TA0400X , with the licence number:  PS00671 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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