Healthcare Provider Details

I. General information

NPI: 1841587870
Provider Name (Legal Business Name): ASSESSMENT AND CONSULTATION SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 06/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 FISH RD
TIVERTON RI
02878-3103
US

IV. Provider business mailing address

PO BOX 272 1061 FISH RD
TIVERTON RI
02878
US

V. Phone/Fax

Practice location:
  • Phone: 401-624-7281
  • Fax: 401-624-7208
Mailing address:
  • Phone: 401-624-7281
  • Fax: 401-624-7208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1016742
License Number StateRI

VIII. Authorized Official

Name: MR. DANIEL GALLAGHER
Title or Position: ADMINISTRATOR
Credential:
Phone: 401-624-7281