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General NPI Number Information
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NPI Number | 1437417839
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Entity Type | Organization
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Legal Business Name | GINA M. IACIOFANO, LLC
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Dates
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Enumeration Date | 04/24/2012
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Last Update Date | 04/24/2012
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Provider Practice Location Address
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Address Line | 1920 MINERAL SPRING AVE UNIT 9
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City | NORTH PROVIDENCE
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State | RI
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Zip | 02904-3742
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Country | US
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Telephone | 401-497-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 1920 MINERAL SPRING AVE UNIT 9
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City | NORTH PROVIDENCE
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State | RI
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Zip | 02904-3742
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Country | US
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Telephone | 401-497-6500
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | GINA M IACIOFANO
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Credential | LICSW
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Telephone | 401-497-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | ISW02121
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License Number State | RI
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