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General NPI Number Information
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NPI Number | 1497788541
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Entity Type | Organization
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Legal Business Name | SANDRA E. DUCLOS, PH.D., INC.
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 10/15/2007
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Provider Practice Location Address
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Address Line | 6 BLACKSTONE VALLEY PL SUITE 109
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City | LINCOLN
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State | RI
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Zip | 02865-1179
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Country | US
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Telephone | 401-334-9104
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Fax | 401-334-9105
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Provider Business Mailing Address
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Address Line | 6 BLACKSTONE VALLEY PL SUITE 109
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City | LINCOLN
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State | RI
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Zip | 02865-1179
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Country | US
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Telephone | 401-334-9104
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Fax | 401-334-9105
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SANDRA E. DUCLOS
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Credential | PH.D.
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Telephone | 401-334-9104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS00498
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License Number State | RI
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