Healthcare Provider Details

I. General information

NPI: 1801342019
Provider Name (Legal Business Name): JENNIFER GAVIRIA MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 05/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLINTON ST
WOONSOCKET RI
02895-3207
US

IV. Provider business mailing address

450 CLINTON ST
WOONSOCKET RI
02895-3207
US

V. Phone/Fax

Practice location:
  • Phone: 401-767-4100
  • Fax: 401-235-6893
Mailing address:
  • Phone: 401-767-4100
  • Fax: 401-235-6893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW02928
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: