Provider Demographics
NPI:1487943536
Name:KRETCHMAN, DANIEL (PHD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:KRETCHMAN
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 1:55 CUMMINGS WAY
Mailing Address - Street 2:PO BOX 1700
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-3247
Mailing Address - Country:US
Mailing Address - Phone:401-235-7000
Mailing Address - Fax:
Practice Address - Street 1:55 CUMMINGS WAY
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-3247
Practice Address - Country:US
Practice Address - Phone:401-235-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS01174103T00000X
TX38749103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist