Healthcare Provider Details

I. General information

NPI: 1497315287
Provider Name (Legal Business Name): MARIO V RITACCO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 W NATICK RD STE 400
WARWICK RI
02886-1161
US

IV. Provider business mailing address

275 W NATICK RD STE 400
WARWICK RI
02886-1161
US

V. Phone/Fax

Practice location:
  • Phone: 401-826-8875
  • Fax: 401-826-8926
Mailing address:
  • Phone: 401-826-8875
  • Fax: 401-826-8926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA00342
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: