Provider Demographics
NPI:1902961642
Name:SQUIRES, DANIEL (PHD, MPH)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:SQUIRES
Suffix:
Gender:M
Credentials:PHD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02880-0367
Mailing Address - Country:US
Mailing Address - Phone:401-474-3595
Mailing Address - Fax:401-615-7544
Practice Address - Street 1:875 CENTERVILLE RD
Practice Address - Street 2:UNIT 2
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4381
Practice Address - Country:US
Practice Address - Phone:401-474-3595
Practice Address - Fax:401-615-7544
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2017-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00980103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical