Provider Demographics
NPI:1699942540
Name:ARMESTO, JORGE C (PHD)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:C
Last Name:ARMESTO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2388
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-0388
Mailing Address - Country:US
Mailing Address - Phone:781-724-9007
Mailing Address - Fax:866-574-0234
Practice Address - Street 1:68 CONSTITUTION ST APT 1
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:RI
Practice Address - Zip Code:02809-2121
Practice Address - Country:US
Practice Address - Phone:781-724-9007
Practice Address - Fax:866-574-0234
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8865103TC0700X, 103TF0200X
RIPS01089103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical