Healthcare Provider Details

I. General information

NPI: 1801935648
Provider Name (Legal Business Name): JUEL H. PLOTKIN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 SALT POND RD #B4
WAKEFIELD RI
02879-4314
US

IV. Provider business mailing address

PO BOX 172
PEACE DALE RI
02883-0172
US

V. Phone/Fax

Practice location:
  • Phone: 401-783-1310
  • Fax: 401-783-7596
Mailing address:
  • Phone: 401-783-6438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number107090
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW00733
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: