Provider Demographics
NPI:1184957482
Name:MATTISON, ALLISON (PSYD)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:MATTISON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 TEN ROD RD.
Mailing Address - Street 2:SUITE E101
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852
Mailing Address - Country:US
Mailing Address - Phone:401-921-5400
Mailing Address - Fax:401-921-5402
Practice Address - Street 1:1130 TEN ROD RD.
Practice Address - Street 2:SUITE E101
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852
Practice Address - Country:US
Practice Address - Phone:401-921-5400
Practice Address - Fax:401-921-5402
Is Sole Proprietor?:No
Enumeration Date:2009-09-18
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
RIPS01285103TC0700X
MEPS1341103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health