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General NPI Number Information
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NPI Number | 1518094846
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Entity Type | Individual
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Provider Name | JEREMY THAYER LICSW
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Gender | Male
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 06/13/2022
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Provider Practice Location Address
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Address Line | 426 SCRABBLETOWN RD
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City | NORTH KINGSTOWN
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State | RI
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Zip | 02852-2001
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Country | US
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Telephone | 401-829-3355
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Fax | 401-667-2733
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Provider Business Mailing Address
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Address Line | 452 GARDINER RD
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City | WEST KINGSTON
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State | RI
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Zip | 02892-1068
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Country | US
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Telephone | 401-829-3355
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Fax | 401-667-2733
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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 | ISW01934
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | CSW00983
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License Number State | RI
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