Provider Demographics
NPI:1467619544
Name:SUMMERS, SHAUNA E (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHAUNA
Middle Name:E
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 WAMPANOAG TRL STE 303
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-2217
Mailing Address - Country:US
Mailing Address - Phone:401-644-7417
Mailing Address - Fax:
Practice Address - Street 1:250 WAMPANOAG TRL STE 303
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-2217
Practice Address - Country:US
Practice Address - Phone:401-644-7417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-17
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS01065103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling