Individual
DR. GERALD DAVID FONTAINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
414 BROADWAY, PROVIDENCE, RI 02909-1621
(401) 272-5665
(401) 272-5665
Mailing address
414 BROADWAY, PROVIDENCE, RI 02909-1621
(401) 272-5665
(401) 272-5665
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS116
RI
Other
Enumeration date
09/04/2006
Last updated
07/08/2007
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