Provider Demographics
NPI:1740477264
Name:FAVALI, JOSEPH (MASTERS)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:FAVALI
Suffix:
Gender:M
Credentials:MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:CENTRAL FALLS
Mailing Address - State:RI
Mailing Address - Zip Code:02863-3029
Mailing Address - Country:US
Mailing Address - Phone:401-726-8080
Mailing Address - Fax:401-726-8007
Practice Address - Street 1:51 CLAY ST
Practice Address - Street 2:
Practice Address - City:CENTRAL FALLS
Practice Address - State:RI
Practice Address - Zip Code:02863-3029
Practice Address - Country:US
Practice Address - Phone:401-726-8080
Practice Address - Fax:401-726-8007
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI30343OtherBLUE CROSS CRISIS