Provider Demographics
NPI:1053740035
Name:ANDERSON-SQUIRES, LLC
Entity type:Organization
Organization Name:ANDERSON-SQUIRES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST; CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SQUIRES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MPH
Authorized Official - Phone:401-474-4004
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02880-0367
Mailing Address - Country:US
Mailing Address - Phone:401-474-3595
Mailing Address - Fax:
Practice Address - Street 1:875 CENTERVILLE RD
Practice Address - Street 2:UNIT 2
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4381
Practice Address - Country:US
Practice Address - Phone:401-474-3595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-11
Last Update Date:2017-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00980103TC0700X
RICSW013701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1902961642OtherTYPE 1 NPI