Healthcare Provider Details

I. General information

NPI: 1053740035
Provider Name (Legal Business Name): ANDERSON-SQUIRES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2013
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:
Mailing address:
  • Phone: 401-474-3595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW01370
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS00980
License Number StateRI

VIII. Authorized Official

Name: DR. DANIEL SQUIRES
Title or Position: CLINICAL PSYCHOLOGIST; CO-OWNER
Credential: PHD, MPH
Phone: 401-474-4004