Provider Demographics
NPI:1831216415
Name:OSOWIECKI, DANA MARGARET (PHD)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:MARGARET
Last Name:OSOWIECKI
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 1:339 ANGELL ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-3245
Mailing Address - Country:US
Mailing Address - Phone:401-421-4561
Mailing Address - Fax:401-521-3456
Practice Address - Street 1:339 ANGELL ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-3245
Practice Address - Country:US
Practice Address - Phone:401-421-4561
Practice Address - Fax:401-521-3456
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00738103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIDO53170Medicaid