Healthcare Provider Details

I. General information

NPI: 1659789980
Provider Name (Legal Business Name): ISRAEL NAVARRO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2014
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 BACON ST
PAWTUCKET RI
02860-5542
US

IV. Provider business mailing address

54 PAULINE ST
DARTMOUTH MA
02747-3428
US

V. Phone/Fax

Practice location:
  • Phone: 401-722-3560
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN48034
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberRN253989
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: