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General NPI Number Information
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NPI Number | 1720951577
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Entity Type | Individual
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Provider Name | ANTHONY S MANSOLILLO
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Gender | Male
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Dates
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Enumeration Date | 09/27/2025
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Last Update Date | 10/18/2025
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Provider Practice Location Address
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Address Line | 345 BLACKSTONE BLVD
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City | PROVIDENCE
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State | RI
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Zip | 02906-4800
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Country | US
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Telephone | 401-455-6365
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Fax |
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Provider Business Mailing Address
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Address Line | 405 WOODHAVEN CT
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City | CRANSTON
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State | RI
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Zip | 02920-2958
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Country | US
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Telephone | 401-699-1790
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN10020475
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License Number State | MA
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