Healthcare Provider Details

I. General information

NPI: 1699984716
Provider Name (Legal Business Name): JEANETTE GIORGI BA, LCDP, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1052 PARK AVE
CRANSTON RI
02910-3225
US

IV. Provider business mailing address

1052 PARK AVE
CRANSTON RI
02910-3225
US

V. Phone/Fax

Practice location:
  • Phone: 401-461-5056
  • Fax: 401-943-2167
Mailing address:
  • Phone: 401-461-5056
  • Fax: 401-943-2167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number00033
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: