Healthcare Provider Details

I. General information

NPI: 1699708677
Provider Name (Legal Business Name): JESSICA SOMERVILLE RUFFOLO PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 CENTERVILLE RD UNIT 2
WARWICK RI
02886-4381
US

IV. Provider business mailing address

875 CENTERVILLE RD UNIT 2
WARWICK RI
02886-4381
US

V. Phone/Fax

Practice location:
  • Phone: 401-529-9921
  • Fax: 401-615-7544
Mailing address:
  • Phone: 401-529-9921
  • Fax: 401-615-7544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS0000896
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: