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Provider Information for 1457601619


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Mr. ALBERT D IANNOTTI Jr. LCSW


Sex: Male

NPI: 1457601619
Last Updated: 2012-09-14
Certification Date:

Details

NameValue
NPI1457601619
Enumeration Date2012-09-14
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 203 CONCORD ST
SUITE 335
PAWTUCKET, RI 02860-3477
United States

Phone: 401-243-7456 | Fax:401-365-6860
 
Primary Practice Address 203 CONCORD ST
SUITE 335
PAWTUCKET, RI 02860-3477
United States

Phone: 401-243-7456 | Fax:401-365-6860
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)RICSW01339Social Work License Number
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 1041C0700X - Social Worker - ClinicalRICSW01339