Healthcare Provider Details

I. General information

NPI: 1356020945
Provider Name (Legal Business Name): JULIA MAIETTA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 PONTIAC AVE
CRANSTON RI
02920-7944
US

IV. Provider business mailing address

47 DANIELSON PIKE
NORTH SCITUATE RI
02857-1892
US

V. Phone/Fax

Practice location:
  • Phone: 401-500-0424
  • Fax: 401-296-3998
Mailing address:
  • Phone: 401-268-5333
  • Fax: 855-268-5333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS02265
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS02265
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: