Provider Demographics
NPI:1558738633
Name:PETER LOSS, ACSW INC
Entity Type:Organization
Organization Name:PETER LOSS, ACSW INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:LOSS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:401-578-3477
Mailing Address - Street 1:PO BOX 397
Mailing Address - Street 2:
Mailing Address - City:EAST LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06333-0397
Mailing Address - Country:US
Mailing Address - Phone:401-578-3477
Mailing Address - Fax:860-739-3702
Practice Address - Street 1:1 RICHMOND SQ
Practice Address - Street 2:SUITE 141C
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5139
Practice Address - Country:US
Practice Address - Phone:401-578-3477
Practice Address - Fax:860-739-3702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW013151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
13595188OtherCAQH
1770968349OtherNPI INDIVIDUAL PROVIDER