Provider Demographics
NPI:1821332727
Name:TORTOLANI, CHRISTINA (PHD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:TORTOLANI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5893 EDDY STREET
Mailing Address - Street 2:PHYSICIAN'S OFFICE BUILDING, # 122
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4141
Mailing Address - Country:US
Mailing Address - Phone:401-444-4515
Mailing Address - Fax:401-444-7018
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:POTTER 3
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-4318
Practice Address - Fax:401-444-6573
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS01341103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIPS01341OtherPROFESSIONAL LICENSE