Healthcare Provider Details

I. General information

NPI: 1982530671
Provider Name (Legal Business Name): DERRICK VICTORINO PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5840 POST RD
EAST GREENWICH RI
02818-2140
US

IV. Provider business mailing address

14 KANE ST
NEW BEDFORD MA
02740-3124
US

V. Phone/Fax

Practice location:
  • Phone: 401-398-7933
  • Fax: 401-329-0001
Mailing address:
  • Phone: 774-305-0538
  • Fax: 774-305-0538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN05222
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: