Basic Information
| Provider Information | |||||||||
| NPI: | 1285703777 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PITASSI | ||||||||
| FirstName: | TULLIO | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | LCDP LMHC PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 148 OLD SNAKE HILL RD | ||||||||
| Address2: | |||||||||
| City: | CHEPACHET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 02814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4015681873 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 50 HEALTH LN | ||||||||
| Address2: | THE KENT CENTER | ||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028862711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017325656 | ||||||||
| FaxNumber: | 4017388634 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2006 | ||||||||
| LastUpdateDate: | 07/23/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 00140 | RI | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | LMHC00070 | RI | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 103T00000X | 2788 | MA | N | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 301118 | 01 | RI | BLUE CROSS | OTHER | 406688 | 01 | RI | BLUE CHIP | OTHER | TP09009 | 05 | RI | MEDICAID | 6244587 | 01 | RI | UBH | OTHER |