Healthcare Provider Details

I. General information

NPI: 1174007900
Provider Name (Legal Business Name): NICOLE MORREO LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE MORREO LP

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 WAMPANOAG TRL STE 9
RIVERSIDE RI
02915-1217
US

IV. Provider business mailing address

1275 WAMPANOAG TRL STE 9
RIVERSIDE RI
02915-1217
US

V. Phone/Fax

Practice location:
  • Phone: 401-352-8440
  • Fax:
Mailing address:
  • Phone: 401-352-8440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number10902
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS01993
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: