MEDICARE: MARTIN WHITE JR. LCDP, CADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDP01096	RI

General Provider Information

NPI Number	:	1053269241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIN WHITE JR. LCDP, CADC

Provider Business Mailing Address
First Line	:	806 GREENVILLE AVE
Second Line	:
City	:	JOHNSTON
State	:	RI
Zip	:	02919-1305
Country	:	US
Telephone Number	:	508-216-5221
Fax Number	:

Provider Business Practice Location Address
First Line	:	806 GREENVILLE AVE
Second Line	:
City	:	JOHNSTON
State	:	RI
Zip	:	02919-1305
Country	:	US
Telephone Number	:	508-216-5221
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2026
Last Update Date	:	03/21/2026

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Directions to “ MARTIN WHITE JR. LCDP, CADC” Practice Location

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