Basic Information
| Provider Information | |||||||||
| NPI: | 1891863437 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHALEN | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | PAUL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 54 TAYLOR DRIVE | ||||||||
| Address2: | |||||||||
| City: | NORTH SMITHFIELD | ||||||||
| State: | RI | ||||||||
| PostalCode: | 02896 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 50 HEALTH LANE | ||||||||
| Address2: | THE KENT CENTER FOR HUMAN & ORGANIZATIONAL DEVELOPMENT | ||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 02886 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017384300 | ||||||||
| FaxNumber: | 4017387718 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | MD9380 | RI | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 7005743 | 05 | RI | MEDICAID | 1553662 | 01 | RI | UBH | OTHER | 400987 | 01 | RI | BLUE CHIP | OTHER | 301369 | 01 | RI | BLUE CROSS | OTHER |