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General NPI Number Information
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NPI Number | 1194884007
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Entity Type | Individual
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Provider Name | DAVID S ELLIOTT PH.D.
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Gender | Male
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 501 ANGELL ST.
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City | PROVIDENCE
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State | RI
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Zip | 02906
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Country | US
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Telephone | 401-868-0350
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Fax |
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Provider Business Mailing Address
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Address Line | 1646 MAIN RD.
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City | WESTPORT POINT
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State | MA
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Zip | 02791-9999
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Country | US
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Telephone | 508-496-7401
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS00499
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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 | 4979
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License Number State | MA
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