Healthcare Provider Details

I. General information

NPI: 1447281696
Provider Name (Legal Business Name): MAXINE B GOLDIN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 ATWOOD AVE
JOHNSTON RI
02919-3223
US

IV. Provider business mailing address

249 ROOSEVELT AVE SUITE 205
PAWTUCKET RI
02860-2134
US

V. Phone/Fax

Practice location:
  • Phone: 401-553-1000
  • Fax: 401-365-1100
Mailing address:
  • Phone: 401-724-8400
  • Fax: 401-365-1100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW00022
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: