=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588001085
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN E ANZIVINO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2013
-----------------------------------------------------
Last Update Date | 05/24/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 267 MAIN ST
-----------------------------------------------------
City | EAST GREENWICH
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02818-3750
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-225-2224
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12 SURREY DR
-----------------------------------------------------
City | JOHNSTON
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02919-2073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-225-2224
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL SOCIAL WORKER
-----------------------------------------------------
Name | MR. JOHN EDWARD ANZIVINO
-----------------------------------------------------
Credential | MSW, ACSW
-----------------------------------------------------
Telephone | 401-225-2224
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | ISW00123
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------