Provider Demographics
NPI:1003958729
Name:URSILLO, PATRICIA ANN (MA LMHC)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANN
Last Name:URSILLO
Suffix:
Gender:F
Credentials:MA LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WATERWHEEL LANE
Mailing Address - Street 2:
Mailing Address - City:NO KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-3315
Mailing Address - Country:US
Mailing Address - Phone:401-295-4442
Mailing Address - Fax:
Practice Address - Street 1:100 WATERWHEEL LANE
Practice Address - Street 2:
Practice Address - City:NO KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-3315
Practice Address - Country:US
Practice Address - Phone:401-295-4442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00041101YA0400X, 101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
70955OtherBLUE CROSS