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General NPI Number Information
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NPI Number | 1558738633
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Entity Type | Organization
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Legal Business Name | PETER LOSS, ACSW INC
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Dates
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Enumeration Date | 08/25/2015
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Last Update Date | 08/25/2015
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Provider Practice Location Address
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Address Line | 1 RICHMOND SQ SUITE 141C
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City | PROVIDENCE
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State | RI
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Zip | 02906-5139
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Country | US
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Telephone | 401-578-3477
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Fax | 860-739-3702
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Provider Business Mailing Address
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Address Line | PO BOX 397
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City | EAST LYME
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State | CT
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Zip | 06333-0397
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Country | US
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Telephone | 401-578-3477
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Fax | 860-739-3702
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. PETER LOSS
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Credential | MSW
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Telephone | 401-578-3477
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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 | ISW01315
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License Number State | RI
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