MEDICARE: MR. RICHARD CHRISTOPHER STATON MSW LICSW CERTIFICAT

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	1041C0700X	Clinical Social Worker	ISW00220	RI

General Provider Information

NPI Number	:	1588689400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD CHRISTOPHER STATON MSW LICSW CERTIFICAT

Provider Business Mailing Address
First Line	:	23 NORTH RD
Second Line	:	LILY PADS PROFESSIONAL CENTER SUITE A-11
City	:	PEACE DALE
State	:	RI
Zip	:	02879-2176
Country	:	US
Telephone Number	:	401-782-4044
Fax Number	:

Provider Business Practice Location Address
First Line	:	23 NORTH RD
Second Line	:	LILY PADS PROFESSIONAL CENTER SUITE A-11
City	:	PEACE DALE
State	:	RI
Zip	:	02879-2176
Country	:	US
Telephone Number	:	401-782-4044
Fax Number	:

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	07/08/2007

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