Healthcare Provider Details

I. General information

NPI: 1750538179
Provider Name (Legal Business Name): RON LAWRENCE CALDARONE LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 BROOKVIEW DRIVE
CRANSTON RI
02921-1601
US

IV. Provider business mailing address

24 BROOKVIEW DRIVE
CRANSTON RI
02921-1601
US

V. Phone/Fax

Practice location:
  • Phone: 401-943-0586
  • Fax:
Mailing address:
  • Phone: 401-943-0586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number00037
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number00037
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: