Healthcare Provider Details

I. General information

NPI: 1518181593
Provider Name (Legal Business Name): PETER M MONTI PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 CHALKSTONE AVE
PROVIDENCE RI
02908-4734
US

IV. Provider business mailing address

830 CHALKSTONE AVE
PROVIDENCE RI
02908-4734
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-1853
  • Fax: 401-444-1888
Mailing address:
  • Phone: 401-444-1853
  • Fax: 401-444-1888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPS0181
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: