Healthcare Provider Details

I. General information

NPI: 1578190831
Provider Name (Legal Business Name): SHAUNA E. SUMMERS, PH.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2020
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 TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. SHAUNA E. SUMMERS
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 401-644-7417