Healthcare Provider Details

I. General information

NPI: 1962511964
Provider Name (Legal Business Name): MICHAEL JOSEPH GUNNING MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 VALLEY RD
MIDDLETOWN RI
02842-5234
US

IV. Provider business mailing address

45 WOODSIA TRL
WAKEFIELD RI
02879-1204
US

V. Phone/Fax

Practice location:
  • Phone: 401-846-6620
  • Fax:
Mailing address:
  • Phone: 401-782-1988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW00072
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: