=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144012519
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES J. LOGAN MSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2025
-----------------------------------------------------
Last Update Date | 05/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2797 POST RD FL 2
-----------------------------------------------------
City | WARWICK
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02886-3001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-300-4828
-----------------------------------------------------
Fax | 401-679-9289
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 92A NIPMUC TRL
-----------------------------------------------------
City | NORTH PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02904-7756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-533-0260
-----------------------------------------------------
Fax | 401-533-0260
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------