Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PS01135 | RI |
Y | 103T00000X | Psychologist | PS01135 | RI |
N | 103TC1900X | Counseling Psychologist | 001135 | RI |
NPI | 1043892649 |
---|---|
Provider Name | David Lichtenstein |
First Address | Riverside, RI 02915-5099 |
Second Address | Riverside, RI 02915-5099 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2021 |
Last Update Date | 27/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001135 | RHODE ISLAND DEPARTMENT OF HEALTH (01) | RI |