Healthcare Provider Details

I. General information

NPI: 1669551404
Provider Name (Legal Business Name): WILLIAM ZINNO LICSW, LCDP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 12/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 BLACKSTONE BLVD WELD BLDG
PROVIDENCE RI
02906-4800
US

IV. Provider business mailing address

345 BLACKSTONE BLVD WELD BLDG
PROVIDENCE RI
02906-4800
US

V. Phone/Fax

Practice location:
  • Phone: 401-421-0060
  • Fax: 401-421-6676
Mailing address:
  • Phone: 401-421-0060
  • Fax: 401-421-6676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW00963
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: