1285703777 NPI number — TULLIO DAVID PITASSI LCDP LMHC PHD

Table of content: TULLIO DAVID PITASSI LCDP LMHC PHD (NPI 1285703777)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285703777 NPI number — TULLIO DAVID PITASSI LCDP LMHC PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PITASSI
Provider First Name:
TULLIO
Provider Middle Name:
DAVID
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCDP LMHC PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285703777
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
148 OLD SNAKE HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHEPACHET
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-568-1873
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 HEALTH LN
Provider Second Line Business Practice Location Address:
THE KENT CENTER
Provider Business Practice Location Address City Name:
WARWICK
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02886-2711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-732-5656
Provider Business Practice Location Address Fax Number:
401-738-8634
Provider Enumeration Date:
11/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  00140 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: LMHC00070 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: 2788 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 301118 . This is a "BLUE CROSS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 406688 . This is a "BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: TP09009 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6244587 . This is a "UBH" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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