Provider Demographics
NPI:1598704132
Name:ROUND, DONALD LESTER (PHD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:LESTER
Last Name:ROUND
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 PAWTUXET AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02905-3920
Mailing Address - Country:US
Mailing Address - Phone:401-461-9941
Mailing Address - Fax:
Practice Address - Street 1:235 PAWTUXET AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02905-3920
Practice Address - Country:US
Practice Address - Phone:401-461-9941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7217103TC0700X
RIPS00966103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA526681Medicaid
MAW05616OtherBCBS
MA526681Medicaid