Healthcare Provider Details

I. General information

NPI: 1184515223
Provider Name (Legal Business Name): JACOB KRAMER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101-103 BACON STREET
PAWTUCKET RI
02860-5542
US

IV. Provider business mailing address

15 LA SALLE SQ
PROVIDENCE RI
02903-1814
US

V. Phone/Fax

Practice location:
  • Phone: 401-722-3560
  • Fax: 401-722-3593
Mailing address:
  • Phone: 401-444-6779
  • Fax: 401-444-6912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW04205
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: