Healthcare Provider Details

I. General information

NPI: 1912461005
Provider Name (Legal Business Name): RHODE ISLAND PSYCHOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2019
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

989 RESERVOIR AVE STE 104
CRANSTON RI
02910-5138
US

IV. Provider business mailing address

989 RESERVOIR AVE STE 104
CRANSTON RI
02910-5138
US

V. Phone/Fax

Practice location:
  • Phone: 401-424-1846
  • Fax: 401-572-3364
Mailing address:
  • Phone: 401-424-1846
  • Fax: 401-572-3364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL SCHAFFER
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PH.D.
Phone: 401-424-1846