Healthcare Provider Details

I. General information

NPI: 1619832946
Provider Name (Legal Business Name): ADOM THERAPEUTIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 CALLA STREET
PROVIDENCE RI
02905
US

IV. Provider business mailing address

137 CALLA STREET
PROVIDENCE RI
02905
US

V. Phone/Fax

Practice location:
  • Phone: 401-742-7211
  • Fax:
Mailing address:
  • Phone: 401-903-4277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CLAUDETTE M BANNERMAN
Title or Position: LICSW
Credential:
Phone: 401-742-7211