Healthcare Provider Details

I. General information

NPI: 1053935080
Provider Name (Legal Business Name): DAVID CARLSEN-LANDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOPPIN ST
PROVIDENCE RI
02903-4141
US

IV. Provider business mailing address

68 HUDSON ST FL 3
PROVIDENCE RI
02909-1904
US

V. Phone/Fax

Practice location:
  • Phone: 972-689-9471
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD20721
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number1014629
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: