=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396805925
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JONATHAN ALLAN SIGMAN MSW LICSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2006
-----------------------------------------------------
Last Update Date | 04/05/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 177 LITTLE REST RD
-----------------------------------------------------
City | KINGSTON
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02881-1612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-480-2198
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 177 LITTLE REST RD
-----------------------------------------------------
City | KINGSTON
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02881-1612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-480-2198
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | ISW01576
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------