Healthcare Provider Details

I. General information

NPI: 1720951577
Provider Name (Legal Business Name): ANTHONY S MANSOLILLO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2025
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CENTURY DR
WORCESTER MA
01606-1244
US

IV. Provider business mailing address

405 WOODHAVEN CT
CRANSTON RI
02920-2958
US

V. Phone/Fax

Practice location:
  • Phone: 774-366-7000
  • Fax:
Mailing address:
  • Phone: 401-699-1790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN10020475
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: