Healthcare Provider Details

I. General information

NPI: 1538813365
Provider Name (Legal Business Name): ALEXIS LOUISE DIGASSO PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2022
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 SMITH ST
PROVIDENCE RI
02908-2700
US

IV. Provider business mailing address

1075 SMITH ST STE 2
PROVIDENCE RI
02908-2700
US

V. Phone/Fax

Practice location:
  • Phone: 401-369-9224
  • Fax:
Mailing address:
  • Phone: 401-369-9224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS02048
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPS02048
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: