Healthcare Provider Details

I. General information

NPI: 1639093503
Provider Name (Legal Business Name): BRYDON CONTI LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LAPHAM FARM RD
PASCOAG RI
02859-4012
US

IV. Provider business mailing address

300 LAPHAM FARM RD
PASCOAG RI
02859-4012
US

V. Phone/Fax

Practice location:
  • Phone: 401-316-0155
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW04538
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: