Healthcare Provider Details

I. General information

NPI: 1275059487
Provider Name (Legal Business Name): JILLIAN MCLEISH MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2017
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 VALLEY RD
MIDDLETOWN RI
02842-6400
US

IV. Provider business mailing address

42 VALLEY RD
MIDDLETOWN RI
02842-6400
US

V. Phone/Fax

Practice location:
  • Phone: 401-846-1213
  • Fax: 401-848-6398
Mailing address:
  • Phone: 401-846-1213
  • Fax: 401-848-6398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW02845
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: