Healthcare Provider Details

I. General information

NPI: 1750527818
Provider Name (Legal Business Name): JAYNE L HALPIN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2008
Last Update Date: 04/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 VETERANS MEMORIAL PKWY
RIVERSIDE RI
02915-5061
US

IV. Provider business mailing address

118 BEACH RD
BRISTOL RI
02809-1532
US

V. Phone/Fax

Practice location:
  • Phone: 401-432-1000
  • Fax:
Mailing address:
  • Phone: 401-316-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number215497
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW02677
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: