Healthcare Provider Details

I. General information

NPI: 1669808473
Provider Name (Legal Business Name): ROBERTO A BACA DNP, ARNP, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2013
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLINTON ST
WOONSOCKET RI
02895-3207
US

IV. Provider business mailing address

450 CLINTON ST
WOONSOCKET RI
02895-3207
US

V. Phone/Fax

Practice location:
  • Phone: 401-767-4100
  • Fax:
Mailing address:
  • Phone: 401-767-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN03635
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9368610
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: