Healthcare Provider Details

I. General information

NPI: 1649207739
Provider Name (Legal Business Name): STEPHEN CORREIA PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VETERANS AFFAIRS MEDICAL CENTER 830 CHALKSTONE AVE. (116)
PROVIDENCE RI
02908-4799
US

IV. Provider business mailing address

VETERANS AFFAIRS MEDICAL CENTER 830 CHALKSTONE AVE. (116)
PROVIDENCE RI
02908-4799
US

V. Phone/Fax

Practice location:
  • Phone: 401-273-7100
  • Fax: 401-457-3371
Mailing address:
  • Phone: 401-273-7100
  • Fax: 401-457-3371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS000796
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: