Healthcare Provider Details

I. General information

NPI: 1639644164
Provider Name (Legal Business Name): PAUL J ROCCHIO HCDP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 10/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 ELMWOOD AVENUE BRIDGEMARK, INC.
WARWICK RI
02888
US

IV. Provider business mailing address

2020 ELMWOOD AVENUE BRIDGEMARK, INC.
WARWICK RI
02888
US

V. Phone/Fax

Practice location:
  • Phone: 401-781-2700
  • Fax: 401-781-2790
Mailing address:
  • Phone: 401-781-2700
  • Fax: 401-781-2790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDP00735
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: