Provider Demographics
NPI:1639317753
Name:STORTI, STEVEN RICHARD (BA, LCDP, ACDP)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:RICHARD
Last Name:STORTI
Suffix:
Gender:M
Credentials:BA, LCDP, ACDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 FODDERING FARM RD
Mailing Address - Street 2:
Mailing Address - City:NARRAGANSETT
Mailing Address - State:RI
Mailing Address - Zip Code:02882-4113
Mailing Address - Country:US
Mailing Address - Phone:401-338-1937
Mailing Address - Fax:401-295-5255
Practice Address - Street 1:144 FODDERING FARM RD
Practice Address - Street 2:
Practice Address - City:NARRAGANSETT
Practice Address - State:RI
Practice Address - Zip Code:02882-4113
Practice Address - Country:US
Practice Address - Phone:401-338-1937
Practice Address - Fax:401-295-5255
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICDP00444101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI164609OtherRHODE ISLAND BOARD OF CHEMICAL DEPENDENCY PROFESSIONALS
RICDP00444OtherSTATE OF RHODE ISLAND