Healthcare Provider Details

I. General information

NPI: 1124297536
Provider Name (Legal Business Name): SPECIALIZED EDUCATION OF RI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 07/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOUGHTON ST
PROVIDENCE RI
02904-1013
US

IV. Provider business mailing address

100 HOUGHTON ST
PROVIDENCE RI
02904
US

V. Phone/Fax

Practice location:
  • Phone: 401-751-5800
  • Fax: 401-751-5900
Mailing address:
  • Phone: 401-751-5800
  • Fax: 401-751-5900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY CLANCY
Title or Position: SCHOOL DIRECTOR
Credential:
Phone: 401-751-5800