Provider Information for 1982008231
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JOHN REARDON LICSW
Sex: Male
NPI: 1982008231
Last Updated: 2014-10-15
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1982008231 | ||||||||
| Enumeration Date | 2014-10-15 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 134 THURBERS AVE PROVIDENCE, RI 02905-4754 United States Phone: 401-331-1350 | Fax:401-277-3366 | ||||||||
| Primary Practice Address | 134 THURBERS AVE PROVIDENCE, RI 02905-4754 United States Phone: 401-331-1350 | Fax:401-277-3366 | ||||||||
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