Provider Demographics
NPI:1124297536
Name:SPECIALIZED EDUCATION OF RI
Entity type:Organization
Organization Name:SPECIALIZED EDUCATION OF RI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SCHOOL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLANCY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-751-5800
Mailing Address - Street 1:100 HOUGHTON ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904
Mailing Address - Country:US
Mailing Address - Phone:401-751-5800
Mailing Address - Fax:401-751-5900
Practice Address - Street 1:100 HOUGHTON ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-1013
Practice Address - Country:US
Practice Address - Phone:401-751-5800
Practice Address - Fax:401-751-5900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Multi-Specialty
No302F00000XManaged Care OrganizationsExclusive Provider OrganizationGroup - Multi-Specialty