Provider Demographics
NPI:1790920668
Name:JOHN D. DAPONTE MENTAL HEALTH THERAPY
Entity Type:Organization
Organization Name:JOHN D. DAPONTE MENTAL HEALTH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:DAPONTE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:401-383-7647
Mailing Address - Street 1:23 AVON RD
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02905-1136
Mailing Address - Country:US
Mailing Address - Phone:401-781-2466
Mailing Address - Fax:
Practice Address - Street 1:105 E MANNING ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4309
Practice Address - Country:US
Practice Address - Phone:401-383-7647
Practice Address - Fax:401-383-7647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI000039MHC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health