Healthcare Provider Details

I. General information

NPI: 1114011756
Provider Name (Legal Business Name): ANGELL STREET PSYCHIATRY LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 01/14/2021
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 COLLEGE HILL RD BLD 29C
WARWICK RI
02886-2776
US

IV. Provider business mailing address

33 COLLEGE HILL RD BLD 29C
WARWICK RI
02886-2776
US

V. Phone/Fax

Practice location:
  • Phone: 401-822-4673
  • Fax: 401-822-4676
Mailing address:
  • Phone: 401-822-4673
  • Fax: 401-822-4676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID E KROESSLER
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 401-822-4673