Healthcare Provider Details

I. General information

NPI: 1205321981
Provider Name (Legal Business Name): BRANDON ST. PIERRE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 CUMBERLAND ST
WOONSOCKET RI
02895-3301
US

IV. Provider business mailing address

PO BOX 1700
WOONSOCKET RI
02895-0856
US

V. Phone/Fax

Practice location:
  • Phone: 401-235-7000
  • Fax:
Mailing address:
  • Phone: 401-235-7000
  • Fax: 401-767-4516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW01978
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: