Healthcare Provider Details

I. General information

NPI: 1588588933
Provider Name (Legal Business Name): ANDREW PAUL JOHN NOTARAS LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LOCKWOOD ST
PROVIDENCE RI
02903-4801
US

IV. Provider business mailing address

22 PARSONAGE ST # 232
PROVIDENCE RI
02903-4732
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-0073
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number04925
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: