Provider Demographics
NPI:1316476450
Name:BUSSOLARI, ANTHONY JOSEPH
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JOSEPH
Last Name:BUSSOLARI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 MINERAL SPRING AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02911-1800
Mailing Address - Country:US
Mailing Address - Phone:413-663-4193
Mailing Address - Fax:
Practice Address - Street 1:463 SWANSEA MALL DR
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777-4119
Practice Address - Country:US
Practice Address - Phone:508-324-4202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-11
Last Update Date:2017-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor