Facts
- Status
- A
- Credential
- LICSW
- Type
- Individual
- Enumeration date
- 2021-05-20
- Last updated
- 2024-11-27
Licenses
- License RI
- ISW03779
- License MA
- LICSW126461
Location
- Practice location
- 302 HARRINGTON AVE
- City
- WARWICK RI
- Postal code
- 028882432
- Phone
- 401-864-3207
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.