Provider Demographics
NPI:1881797868
Name:PORTO, ANN M (PSYD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:PORTO
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 1:75 NEWMAN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RUMFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02916-3606
Mailing Address - Country:US
Mailing Address - Phone:401-453-0666
Mailing Address - Fax:401-453-9619
Practice Address - Street 1:1524 ATWOOD AVE
Practice Address - Street 2:SUITE 213
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-3228
Practice Address - Country:US
Practice Address - Phone:401-351-0400
Practice Address - Fax:401-351-0410
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00486103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI30232-0OtherBLUE SHIELD PROVIDER #
RI204670OtherBLUE CHIP PROVIDER #
RI007005280Medicare ID - Type Unspecified