Provider Demographics
NPI:1174767552
Name:ADLER, ANN K (PHD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:K
Last Name:ADLER
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 1:49 PAVILION AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-1534
Mailing Address - Country:US
Mailing Address - Phone:401-490-8900
Mailing Address - Fax:401-490-2619
Practice Address - Street 1:49 PAVILION AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-1534
Practice Address - Country:US
Practice Address - Phone:401-490-8900
Practice Address - Fax:401-490-2619
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7231103T00000X
RIPS000874103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist