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General NPI Number Information
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NPI Number | 1053766733
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Entity Type | Individual
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Provider Name | KAYLA MOURATO
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Gender | Female
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Dates
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Enumeration Date | 04/29/2016
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Last Update Date | 08/02/2022
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Provider Practice Location Address
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Address Line | 225 NEWMAN AVE
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City | RUMFORD
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State | RI
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Zip | 02916-1218
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Country | US
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Telephone | 508-838-9606
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Fax |
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Provider Business Mailing Address
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Address Line | 10 MEADOWBROOK RD
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City | BROCKTON
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State | MA
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Zip | 02301-7122
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | LBA00278
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License Number State | RI
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