Provider Demographics
NPI:1518977024
Name:SAKONNET PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:SAKONNET PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CERBO
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:401-624-9981
Mailing Address - Street 1:PO BOX 272
Mailing Address - Street 2:
Mailing Address - City:TIVERTON
Mailing Address - State:RI
Mailing Address - Zip Code:02878
Mailing Address - Country:US
Mailing Address - Phone:401-624-9981
Mailing Address - Fax:401-462-2111
Practice Address - Street 1:1061 FISH RD
Practice Address - Street 2:
Practice Address - City:TIVERTON
Practice Address - State:RI
Practice Address - Zip Code:02878-3103
Practice Address - Country:US
Practice Address - Phone:401-624-9981
Practice Address - Fax:401-462-2111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS460103TC0700X
MA6166103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty