Healthcare Provider Details

I. General information

NPI: 1912707928
Provider Name (Legal Business Name): DHIRA PATEL PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 BLACKSTONE BLVD STE 1
PROVIDENCE RI
02906-4800
US

IV. Provider business mailing address

445 TOLL GATE RD PRC AND CREDENTIALING
WARWICK RI
02886-2759
US

V. Phone/Fax

Practice location:
  • Phone: 401-455-6402
  • Fax: 401-455-6405
Mailing address:
  • Phone: 401-273-0641
  • Fax: 401-273-2919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS02339
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY10001067
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS02339
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: