Healthcare Provider Details

I. General information

NPI: 1265578058
Provider Name (Legal Business Name): RICHARD CHARTIER LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 HARTFORD AVE
JOHNSTON RI
02919-7109
US

IV. Provider business mailing address

21 PHENIX AVE
CRANSTON RI
02920-4222
US

V. Phone/Fax

Practice location:
  • Phone: 401-519-1940
  • Fax: 401-351-6613
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW00819
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number105311
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: