Healthcare Provider Details

I. General information

NPI: 1003892209
Provider Name (Legal Business Name): NAIR C CARDOSO LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 WAMPANOAG TRAIL
RIVERSIDE RI
02915-1506
US

IV. Provider business mailing address

220 WOODHAVEN RD
PAWTUCKET RI
02861-3841
US

V. Phone/Fax

Practice location:
  • Phone: 401-431-9870
  • Fax: 401-435-7486
Mailing address:
  • Phone: 401-728-3707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberISW01507
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number11Z094
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: