| Providence Behavioral Health Associates Inc | |
|
1075 Smith St Providence RI 02908-2700 | |
| (401) 369-9224 | |
| (401) 369-9275 |
| Full Name | Providence Behavioral Health Associates Inc |
|---|---|
| Speciality | Psychologist |
| Location | 1075 Smith St, Providence, Rhode Island |
| Authorized Official Name and Position | John F. Todaro (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 4013699224 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Behavioral Health Associates Inc 1075 Smith St Providence RI 02908-2700 Ph: (401) 369-9224 | Providence Behavioral Health Associates Inc 1075 Smith St Providence RI 02908-2700 Ph: (401) 369-9224 |
| NPI Number | 1023142700 |
|---|---|
| Provider Enumeration Date | 03/15/2007 |
| Last Update Date | 05/04/2021 |
| Certification Date | 05/04/2021 |
| Medicare PECOS PAC ID | 3274798236 |
|---|---|
| Medicare Enrollment ID | O20120626000461 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023142700 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PS00948 (Rhode Island) | Primary |
| Provider Name | Rita A Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841418464 PECOS PAC ID: 1557335676 Enrollment ID: I20040824001174 |
| Provider Name | Donald Kieffer |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1053395665 PECOS PAC ID: 8921059304 Enrollment ID: I20050202000856 |
| Provider Name | Pamela Messore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912092040 PECOS PAC ID: 1850310327 Enrollment ID: I20051114000837 |
| Provider Name | Terri Lupoli |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306885223 PECOS PAC ID: 2961403043 Enrollment ID: I20070117000201 |
| Provider Name | Nina Mackta |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851493621 PECOS PAC ID: 1254435589 Enrollment ID: I20070327000291 |
| Provider Name | John F Todaro |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1487689089 PECOS PAC ID: 1557366028 Enrollment ID: I20071204000536 |
| Provider Name | Barbara J Forloney |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1215108717 PECOS PAC ID: 8325111628 Enrollment ID: I20080721000101 |
| Provider Name | Lisa Fiore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356679856 PECOS PAC ID: 1951442151 Enrollment ID: I20100111000299 |
| Provider Name | Elizabeth Anne Mangiameli |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649444209 PECOS PAC ID: 4284893793 Enrollment ID: I20120301000714 |
| Provider Name | Randi J Braunstein |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225156409 PECOS PAC ID: 4082863345 Enrollment ID: I20121001000277 |
| Provider Name | John Charette |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003123498 PECOS PAC ID: 9133353444 Enrollment ID: I20130927000429 |
| Provider Name | Jonathan V Dela Luna |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1649591421 PECOS PAC ID: 8426278953 Enrollment ID: I20141006001509 |
| Provider Name | Julie F Grand-landau |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861746224 PECOS PAC ID: 9234358177 Enrollment ID: I20160526001289 |
| Provider Name | Erin M Rabideau |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1932658044 PECOS PAC ID: 4789966920 Enrollment ID: I20170123001868 |
| Provider Name | Michael D Brodeur |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1225375165 PECOS PAC ID: 3870852239 Enrollment ID: I20180111000681 |
| Provider Name | Michael Geoghegan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699290924 PECOS PAC ID: 5698035145 Enrollment ID: I20190920000075 |
| Provider Name | Leah Elizabeth Shavalier |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1063720779 PECOS PAC ID: 0143552141 Enrollment ID: I20191024000282 |
| Provider Name | Megan St. Angelo |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1588119267 PECOS PAC ID: 1052743481 Enrollment ID: I20191122001814 |
| Provider Name | Diane L Marolla |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538646500 PECOS PAC ID: 7214261874 Enrollment ID: I20200930003130 |
| Provider Name | Joanna Winterbottom |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710577234 PECOS PAC ID: 1759797327 Enrollment ID: I20210305000086 |
| Provider Name | Megan Strathearn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023460748 PECOS PAC ID: 3274938857 Enrollment ID: I20210819001601 |
| Provider Name | Alexis Louise Digasso |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1538813365 PECOS PAC ID: 4981090131 Enrollment ID: I20220415000551 |
| Provider Name | Lorraine M Ruocco |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1285063818 PECOS PAC ID: 4183002777 Enrollment ID: I20220610000965 |
| Provider Name | Donna Marie Mcdonald |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760858211 PECOS PAC ID: 2860861705 Enrollment ID: I20221215000685 |
| Provider Name | Christopher Hicks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710394994 PECOS PAC ID: 9234457482 Enrollment ID: I20221215001427 |
| Provider Name | Christopher Bruce Anderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912685306 PECOS PAC ID: 5890157341 Enrollment ID: I20230815002236 |
| Provider Name | Olivia Footer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154002665 PECOS PAC ID: 0446607758 Enrollment ID: I20231108001529 |
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