Provider Demographics
NPI:1285703777
Name:PITASSI, TULLIO DAVID (LCDP LMHC PHD)
Entity type:Individual
Prefix:
First Name:TULLIO
Middle Name:DAVID
Last Name:PITASSI
Suffix:
Gender:M
Credentials:LCDP LMHC PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 OLD SNAKE HILL RD
Mailing Address - Street 2:
Mailing Address - City:CHEPACHET
Mailing Address - State:RI
Mailing Address - Zip Code:02814
Mailing Address - Country:US
Mailing Address - Phone:401-568-1873
Mailing Address - Fax:
Practice Address - Street 1:50 HEALTH LN
Practice Address - Street 2:THE KENT CENTER
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2711
Practice Address - Country:US
Practice Address - Phone:401-732-5656
Practice Address - Fax:401-738-8634
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00140101YA0400X
RILMHC00070101YM0800X
MA2788103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI301118OtherBLUE CROSS
RI406688OtherBLUE CHIP
RITP09009Medicaid
RI6244587OtherUBH