Healthcare Provider Details

I. General information

NPI: 1669402988
Provider Name (Legal Business Name): JOSEPH J TRUNZO PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 WATERMAN ST
PROVIDENCE RI
02906-3116
US

IV. Provider business mailing address

154 WATERMAN ST
PROVIDENCE RI
02906-3116
US

V. Phone/Fax

Practice location:
  • Phone: 401-273-3322
  • Fax:
Mailing address:
  • Phone: 401-273-3322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0777
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: