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General NPI Number Information
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NPI Number | 1144709932
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Entity Type | Organization
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Legal Business Name | CHANGESPACE CENTER FOR COUNSELING AND DEVELOPMENT LLC
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Dates
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Enumeration Date | 08/13/2018
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Last Update Date | 08/13/2018
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Provider Practice Location Address
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Address Line | 147 COUNTY RD STE 300A-B
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City | BARRINGTON
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State | RI
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Zip | 02806-4536
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Country | US
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Telephone | 401-263-4361
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Fax |
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Provider Business Mailing Address
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Address Line | 4 MIDDLE ST
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City | BARRINGTON
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State | RI
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Zip | 02806-1924
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Country | US
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Telephone | 401-263-4361
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Fax |
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Authorized Official
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Title or Position | CO-OWNER/THERAPIST
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Name | ALEXANDER LAORENZA
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Credential | LICSW
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Telephone | 401-263-4361
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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 | ISW02166
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License Number State | RI
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