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General NPI Number Information
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NPI Number | 1427396456
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Entity Type | Individual
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Provider Name | MELINDA GUSHWA PHD, MSW
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Gender | Female
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Dates
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Enumeration Date | 01/25/2013
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Last Update Date | 01/25/2013
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Provider Practice Location Address
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Address Line | 1070 MAIN ST FELLOWSHIP BEHAVIORAL HEALTHCARE SERVICES
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City | PAWTUCKET
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State | RI
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Zip | 02860-4974
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Country | US
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Telephone | 401-721-5910
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Fax |
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Provider Business Mailing Address
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Address Line | 600 MOUNT PLEASANT AVE RHODE ISLAND COLLEGE SCHOOL OF SOCIAL WORK
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City | PROVIDENCE
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State | RI
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Zip | 02908-1940
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Country | US
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Telephone | 401-456-8627
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Fax |
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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 | CSW01487
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License Number State | RI
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