=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184781544
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT BRENNAN ARCHER MSW, LICSW, ED. D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2007
-----------------------------------------------------
Last Update Date | 08/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 31 JOHN CLARKE RD
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02842-5641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-848-4111
-----------------------------------------------------
Fax | 401-849-2300
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29 GIDLEY ST
-----------------------------------------------------
City | NEWPORT
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02840-3443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-849-5489
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | ISW00750
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------