Provider Demographics
NPI:1114582806
Name:ASPIRE PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:ASPIRE PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:DANG
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:860-888-3833
Mailing Address - Street 1:50 MAIN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-3827
Mailing Address - Country:US
Mailing Address - Phone:860-888-3833
Mailing Address - Fax:
Practice Address - Street 1:50 MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-3827
Practice Address - Country:US
Practice Address - Phone:860-888-3833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty