Healthcare Provider Details

I. General information

NPI: 1861228009
Provider Name (Legal Business Name): JACOB HANDANYAN MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2024
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 TEN ROD RD STE B101
NORTH KINGSTOWN RI
02852-4165
US

IV. Provider business mailing address

1130 TEN ROD RD STE B101
NORTH KINGSTOWN RI
02852-4165
US

V. Phone/Fax

Practice location:
  • Phone: 401-294-3990
  • Fax:
Mailing address:
  • Phone: 401-294-3990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCSW03844
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: