Provider Demographics
NPI:1023142700
Name:PROVIDENCE BEHAVIORAL HEALTH ASSOCIATES INC
Entity type:Organization
Organization Name:PROVIDENCE BEHAVIORAL HEALTH ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:TODARO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:401-369-9224
Mailing Address - Street 1:1075 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-2700
Mailing Address - Country:US
Mailing Address - Phone:401-369-9224
Mailing Address - Fax:
Practice Address - Street 1:1075 SMITH ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-2700
Practice Address - Country:US
Practice Address - Phone:401-369-9224
Practice Address - Fax:401-369-9275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00948103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty