Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 06567 | MD |
N | 103TC0700X | Clinical Psychologist | 06567 | MD |
Y | 103G00000X | Clinical Psychologist | PS02024 | RI |
Y | 103TC0700X | Clinical Psychologist | PS02024 | RI |
NPI | 1003472200 |
---|---|
Provider Name | Dr. Vamsi C Tummalachetty |
First Address | Providence, RI 02905-4541 |
Second Address | Riverside, RI 02915-5061 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2019 |
Last Update Date | 22/12/2021 |