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Behavioral Health & Social Service Providers Social Worker

Provider NPI: 1497732796

Provider Information:
Gender: M

Practice Location:
Tel: 207-438-1130  Fax: 207-438-2438

Business Mailing Address:
Tel: 401-841-4522  Fax: 401-841-4128

NPI Information:
NPI: 1497732796
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y104100000XBehavioral Health & Social Service Providers
Social Worker

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 104100000X





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