Provider Demographics
NPI:1518927144
Name:PATISTEA, CYNTHIA ANN (MED)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:ANN
Last Name:PATISTEA
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 ROGERS LANE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842
Mailing Address - Country:US
Mailing Address - Phone:401-849-4147
Mailing Address - Fax:
Practice Address - Street 1:2 OLD COUNTY RD
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:RI
Practice Address - Zip Code:02806-1602
Practice Address - Country:US
Practice Address - Phone:401-246-1195
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICP42015101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RICP42015Medicaid