Healthcare Provider Details

I. General information

NPI: 1669494589
Provider Name (Legal Business Name): WILLIAM S UNGER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 CHALKSTONE AVE
PROVIDENCE RI
02908
US

IV. Provider business mailing address

830 CHALKSTONE AVE
PROVIDENCE RI
02908-4734
US

V. Phone/Fax

Practice location:
  • Phone: 401-457-3077
  • Fax: 401-457-3354
Mailing address:
  • Phone: 401-457-3077
  • Fax: 401-457-3354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS-408
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: