Healthcare Provider Details

I. General information

NPI: 1457337776
Provider Name (Legal Business Name): IWONA CHELMINSKI PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 04/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 W RIVER ST SUITE 11 B
PROVIDENCE RI
02904-2609
US

IV. Provider business mailing address

593 EDDY ST POTTER 3
PROVIDENCE RI
02903-4923
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-7442
  • Fax: 401-444-7109
Mailing address:
  • Phone: 401-444-4318
  • Fax: 401-444-6573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS00724
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: