Healthcare Provider Details

I. General information

NPI: 1740323567
Provider Name (Legal Business Name): RUTH ELAINE ANDERSON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 SALT POND RD B-4
WAKEFIELD RI
02879-4314
US

IV. Provider business mailing address

17 NICHOLS RD
KINGSTON RI
02881-1803
US

V. Phone/Fax

Practice location:
  • Phone: 401-783-1310
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS314
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: