Healthcare Provider Details

I. General information

NPI: 1467619544
Provider Name (Legal Business Name): SHAUNA E. SUMMERS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2008
Last Update Date: 05/05/2024
Certification Date: 05/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 HARVARD AVE
WARWICK RI
02889-2115
US

IV. Provider business mailing address

31 HARVARD AVE
WARWICK RI
02889-2115
US

V. Phone/Fax

Practice location:
  • Phone: 401-644-7417
  • Fax: 877-603-8031
Mailing address:
  • Phone: 401-644-7417
  • Fax: 877-603-8031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number4222
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY11566
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPS01065
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: