Healthcare Provider Details

I. General information

NPI: 1881797868
Provider Name (Legal Business Name): ANN M PORTO PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 ATWOOD AVE SUITE 213
JOHNSTON RI
02919-3228
US

IV. Provider business mailing address

75 NEWMAN AVE SUITE 100
RUMFORD RI
02916-3606
US

V. Phone/Fax

Practice location:
  • Phone: 401-351-0400
  • Fax: 401-351-0410
Mailing address:
  • Phone: 401-453-0666
  • Fax: 401-453-9619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS00486
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: