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General NPI Number Information
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NPI Number | 1104981448
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Entity Type | Individual
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Provider Name | JANE BORELLI-LOOMIS LICSW
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Gender | Female
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 134 THURBERS AVE
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City | PROVIDENCE
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State | RI
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Zip | 02905-4754
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Country | US
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Telephone | 401-331-1350
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Fax | 401-277-3366
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Provider Business Mailing Address
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Address Line | 40 SAUNDERS BROOK RD
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City | CHEPACHET
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State | RI
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Zip | 02814-2003
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Country | US
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Telephone | 401-331-1350
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Fax | 401-277-3366
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ISW00285
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License Number State | RI
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