Healthcare Provider Details

I. General information

NPI: 1902961642
Provider Name (Legal Business Name): DANIEL SQUIRES PHD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 04/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 CENTERVILLE RD UNIT 2
WARWICK RI
02886-4381
US

IV. Provider business mailing address

PO BOX 367
WAKEFIELD RI
02880-0367
US

V. Phone/Fax

Practice location:
  • Phone: 401-474-3595
  • Fax: 401-615-7544
Mailing address:
  • Phone: 401-474-3595
  • Fax: 401-615-7544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS00980
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: