Healthcare Provider Details

I. General information

NPI: 1295410694
Provider Name (Legal Business Name): SAFE INTEGRATION WORKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 GARDEN ST
PAWTUCKET RI
02860-3705
US

IV. Provider business mailing address

109 GARDEN ST
PAWTUCKET RI
02860-3705
US

V. Phone/Fax

Practice location:
  • Phone: 774-719-7824
  • Fax:
Mailing address:
  • Phone: 401-753-8543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JUSTICE GOMES
Title or Position: PROVIDER
Credential:
Phone: 401-753-8543