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General NPI Number Information
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NPI Number | 1053740035
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Entity Type | Organization
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Legal Business Name | ANDERSON-SQUIRES, LLC
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Dates
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Enumeration Date | 11/11/2013
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Last Update Date | 04/29/2017
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Provider Practice Location Address
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Address Line | 875 CENTERVILLE RD UNIT 2
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City | WARWICK
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State | RI
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Zip | 02886-4381
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Country | US
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Telephone | 401-474-3595
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 367
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City | WAKEFIELD
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State | RI
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Zip | 02880-0367
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Country | US
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Telephone | 401-474-3595
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST; CO-OWNER
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Name | DR. DANIEL SQUIRES
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Credential | PHD, MPH
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Telephone | 401-474-4004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW01370
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS00980
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License Number State | RI
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