Healthcare Provider Details

I. General information

NPI: 1275446189
Provider Name (Legal Business Name): UNJADED CLINICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 SALT POND RD STE G1
SOUTH KINGSTOWN RI
02879-4325
US

IV. Provider business mailing address

107 WOODVILLE RD
HOPE VALLEY RI
02832-2427
US

V. Phone/Fax

Practice location:
  • Phone: 401-575-7873
  • Fax:
Mailing address:
  • Phone: 401-575-7873
  • 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: ALEXIS DESJARDINS
Title or Position: OWNER
Credential:
Phone: 401-575-7873