Provider Demographics
NPI:1154722171
Name:CENTER FOR PSYCHOLOGY AND LEARNING
Entity type:Organization
Organization Name:CENTER FOR PSYCHOLOGY AND LEARNING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:OSOWIECKI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:401-527-8617
Mailing Address - Street 1:340 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02909-1102
Mailing Address - Country:US
Mailing Address - Phone:401-421-4561
Mailing Address - Fax:401-521-3456
Practice Address - Street 1:340 BROADWAY
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02909-1102
Practice Address - Country:US
Practice Address - Phone:401-421-4561
Practice Address - Fax:401-521-3456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00738103G00000X
RIPS1153103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty