Healthcare Provider Details

I. General information

NPI: 1922210731
Provider Name (Legal Business Name): ANN PORTO PSYD & ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/15/2008
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
02916-1945
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 Number
License Number State

VIII. Authorized Official

Name: ANN PORTO
Title or Position: PRESIDENT
Credential: PSYD
Phone: 401-351-0400