Healthcare Provider Details

I. General information

NPI: 1114041076
Provider Name (Legal Business Name): ROBERT ALEXANDER MARZILLI PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 ATWOOD AVE STE. NO. 433
JOHNSTON RI
02919-3228
US

IV. Provider business mailing address

33 SWEET HILL DR
JOHNSTON RI
02919-2231
US

V. Phone/Fax

Practice location:
  • Phone: 401-861-2190
  • Fax:
Mailing address:
  • Phone: 401-231-5717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS00233
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: