Healthcare Provider Details

I. General information

NPI: 1295624047
Provider Name (Legal Business Name): MOZART M. TELLES CNS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2025
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 DORRANCE ST STE 706
PROVIDENCE RI
02903-2014
US

IV. Provider business mailing address

10 DORRANCE ST STE 706
PROVIDENCE RI
02903-2014
US

V. Phone/Fax

Practice location:
  • Phone: 401-447-4241
  • Fax: 401-804-0401
Mailing address:
  • Phone: 401-447-4142
  • Fax: 401-804-0401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0810X
TaxonomyChild & Family Psychiatric/Mental Health Clinical Nurse Specialist
License NumberAPRN05026
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code364SP0813X
TaxonomyGeropsychiatric Psychiatric/Mental Health Clinical Nurse Specialist
License NumberAPRN05026
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberAPRN05026
License Number StateRI
# 4
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberAPRN05026
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: