Healthcare Provider Details

I. General information

NPI: 1184049017
Provider Name (Legal Business Name): MOMENTUM INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2014
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491 KILVERT ST
WARWICK RI
02886-1370
US

IV. Provider business mailing address

491 KILVERT ST
WARWICK RI
02886-1370
US

V. Phone/Fax

Practice location:
  • Phone: 401-618-6991
  • Fax: 401-618-6995
Mailing address:
  • Phone: 401-618-6991
  • Fax: 401-618-6995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberPS00945
License Number StateRI

VIII. Authorized Official

Name: DR. ANDREA CHAIT
Title or Position: PRESIDENT
Credential: PH.D., BCBA-D, LBA
Phone: 401-808-0069