Healthcare Provider Details

I. General information

NPI: 1124747365
Provider Name (Legal Business Name): LOGAN MUNNERLYN ENGLAND LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 JOHN A CUMMINGS WAY
WOONSOCKET RI
02895-3244
US

IV. Provider business mailing address

1724 MAIN ST APT 2
WEST WARWICK RI
02893-7437
US

V. Phone/Fax

Practice location:
  • Phone: 401-767-4100
  • Fax:
Mailing address:
  • Phone: 401-601-8766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW02751
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW04354
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: