Healthcare Provider Details

I. General information

NPI: 1972815249
Provider Name (Legal Business Name): BARBARA NADIA JANDASEK PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2010
Last Update Date: 03/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOPPIN ST SUITE 204
PROVIDENCE RI
02903-4141
US

IV. Provider business mailing address

117 ELLENFIELD ST SUITE 101
PROVIDENCE RI
02905-4513
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-8945
  • Fax: 401-444-8742
Mailing address:
  • Phone: 401-444-4318
  • Fax: 401-444-6573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPS01175
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPS01175
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: