=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487689089
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN F TODARO PH.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2006
-----------------------------------------------------
Last Update Date | 05/23/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1086 SMITH STREET
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 20908-2738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-277-0658
-----------------------------------------------------
Fax | 866-448-1380
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1086 SMITH ST
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02908-2738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-369-9224
-----------------------------------------------------
Fax | 401-369-9275
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PS00948
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------