Provider Demographics
NPI:1497315287
Name:RITACCO, MARIO V
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:V
Last Name:RITACCO
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 1:275 W NATICK RD STE 400
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1161
Mailing Address - Country:US
Mailing Address - Phone:401-826-8875
Mailing Address - Fax:401-826-8926
Practice Address - Street 1:275 W NATICK RD STE 400
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1161
Practice Address - Country:US
Practice Address - Phone:401-826-8875
Practice Address - Fax:401-826-8926
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
RILBA00342103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RILBA00342Medicaid