Healthcare Provider Details

I. General information

NPI: 1598704132
Provider Name (Legal Business Name): DONALD LESTER ROUND PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 01/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 PAWTUXET AVE
CRANSTON RI
02905-3920
US

IV. Provider business mailing address

235 PAWTUXET AVE
CRANSTON RI
02905-3920
US

V. Phone/Fax

Practice location:
  • Phone: 401-461-9941
  • Fax:
Mailing address:
  • Phone: 401-461-9941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number7217
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS00966
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: