Healthcare Provider Details

I. General information

NPI: 1720311202
Provider Name (Legal Business Name): DELTA CONSULTANTS PROVIDENCE/ATTLE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2009
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 REGENCY PLZ SUITE 12
PROVIDENCE RI
02903-3160
US

IV. Provider business mailing address

2 REGENCY PLZ SUITE 12
PROVIDENCE RI
02903-3160
US

V. Phone/Fax

Practice location:
  • Phone: 401-421-1405
  • Fax: 401-331-8223
Mailing address:
  • Phone: 401-421-1405
  • Fax: 401-331-8223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD SOLOMON
Title or Position: CLINICAL DIRECTOR
Credential: PH.D.
Phone: 401-421-1405