Basic Information
| Provider Information | |||||||||
| NPI: | 1689860611 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARVALHO | ||||||||
| FirstName: | JANESSA | ||||||||
| MiddleName: | O. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 MILL RD STE 180 | ||||||||
| Address2: | |||||||||
| City: | FAIRHAVEN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027195255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089732000 | ||||||||
| FaxNumber: | 5089732001 | ||||||||
| Practice Location | |||||||||
| Address1: | 480 HAWTHORN ST | ||||||||
| Address2: | |||||||||
| City: | NORTH DARTMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027473729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089900963 | ||||||||
| FaxNumber: | 5089901176 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2007 | ||||||||
| LastUpdateDate: | 04/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | 01374 | RI | N | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | 103T00000X | N | Behavioral Health & Social Service Providers | Psychologist | 103TC0700X | 01374 | RI | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.