Chonlada Jarukitisakul, PHD

Key facts

NPI

1962024869

Entity type

Individual (NPI type 1)

Primary specialty

Psychologist 103T00000X

License

PS01791 (RI)

Practice address

450 Brook Street
Providence, RI 02906

Phone

(401) 863-3476

NPI assigned

May 13, 2020

Sex

Female

Sole proprietor

Yes

Medicare Care Compare profile

Specialty

Clinical Psychologist

Education

Other, 2018

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Philosophy

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 13, 2026.

{
    "created_epoch": "1589328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786579200000",
    "number": "1962024869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "69 BROWN STREET BOX 1960",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029120001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 BROOK STREET",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "02906",
            "telephone_number": "401-863-3476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JARUKITISAKUL",
        "first_name": "CHONLADA",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-05-13",
        "last_updated": "2026-08-13",
        "certification_date": "2026-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "RI",
            "license": "PS01791",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MA",
            "license": "11069-PY-PR",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

• Melissa Jantz, LMHC
• Jar Consulting Inc
• Angela Jarman
• Jo Ann M Jarnac, M.S., CCC-SLP
• Jana Jarolimova, MD
• Sarah Jasinski, PHD
• Julia Marie Jasper, PHARMD, RPH
• Katherine A Jaswell, LCSW
• Maheen Javaid
• Carolyn Javier

All providers in Providence, RI · Psychologist in Rhode Island