Healthcare Provider Details

I. General information

NPI: 1114137585
Provider Name (Legal Business Name): CHILD HEALTH & BEHAVIOR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 WATERMAN ST
PROVIDENCE RI
02906-3116
US

IV. Provider business mailing address

990 MAIN ST
WEST BARNSTABLE MA
02668-1143
US

V. Phone/Fax

Practice location:
  • Phone: 401-273-3322
  • Fax: 508-375-0077
Mailing address:
  • Phone: 508-375-9922
  • Fax: 508-375-0077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW DANIELS
Title or Position: DIRECTOR
Credential: M.A., LMHC
Phone: 508-375-9922