Provider Demographics
NPI:1114544533
Name:HIGHLAND, SAMUEL V (PSYD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:V
Last Name:HIGHLAND
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 WAMPANOAG TRL STE 3C
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-1217
Mailing Address - Country:US
Mailing Address - Phone:401-206-0304
Mailing Address - Fax:855-595-1087
Practice Address - Street 1:1275 WAMPANOAG TRL STE 3C
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-1217
Practice Address - Country:US
Practice Address - Phone:401-206-0304
Practice Address - Fax:855-595-1087
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2024-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPSY10000589103TC0700X
RIPS02118103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical