Healthcare Provider Details

I. General information

NPI: 1235263484
Provider Name (Legal Business Name): JUDITH GORMAN LCSW,LCDCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 EAST ST
CRANSTON RI
02920-4421
US

IV. Provider business mailing address

80 EAST ST
CRANSTON RI
02920-4421
US

V. Phone/Fax

Practice location:
  • Phone: 401-463-6001
  • Fax: 401-463-8572
Mailing address:
  • Phone: 401-463-6001
  • Fax: 401-463-8572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDS00049
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLADC I-1072
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW00684
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: