Individual provider Active NPI

Melissa Anne Buttaro, PH.D.

  • Psychologist
  • Providence, RI
National Provider Identifier
1508094590
Registry record updated Jun 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PS01131 Issued in RI
Practice address
1 Hoppin St
Suite 317
Providence, RI 02903-4141
Phone
(401) 793-8740
Fax
(401) 444-7865
NPI assigned
Jun 29, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PS01131 RI Primary
Clinical Child & Adolescent Psychologist 103TC2200X PS01131 RI
Clinical Neuropsychologist 103G00000X PS01131 RI

Addresses

Primary practice location

1 Hoppin St
Suite 317
Providence, RI 02903-4141

Mailing address

593 Eddy St
Apc 978
Providence, RI 02903-4923
Phone (401) 444-4318

Other identifiers 1

IdentifierTypeStateIssuer
PS01131OtherRIRI PROFESSIONAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091020000122 RI Practitioner - Clinical Psychologist 1254478597 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lifespan Physician Group IncGroup PAC ID 2567455082, 1,151 clinicians

Practice addresses (Care Compare)

146 W River St
Suite 11B
Providence, RI 02904-2609
Phone (401) 444-7442

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PS01131RIMDClinical Neuropsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Rhode Island Hospital Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1246233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403049600000",
    "number": "1508094590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "593 EDDY ST",
            "address_2": "APC 978",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034923",
            "telephone_number": "401-444-4318",
            "fax_number": "401-444-7865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 HOPPIN ST",
            "address_2": "SUITE 317",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034141",
            "telephone_number": "401-793-8740",
            "fax_number": "401-444-7865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUTTARO",
        "first_name": "MELISSA",
        "middle_name": "ANNE",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-29",
        "last_updated": "2014-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "RI",
            "license": "PS01131",
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "RI",
            "license": "PS01131",
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "RI",
            "license": "PS01131",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RI PROFESSIONAL LICENSE",
            "identifier": "PS01131",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.