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General NPI Number Information
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NPI Number | 1770898132
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Entity Type | Organization
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Legal Business Name | ALEXIS T. SCHONROG, LICSW, LLC
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Dates
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Enumeration Date | 08/10/2010
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Last Update Date | 08/10/2010
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Provider Practice Location Address
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Address Line | 97 CROSS ST
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City | WESTERLY
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State | RI
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Zip | 02891-2448
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Country | US
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Telephone | 401-596-8802
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Fax | 401-596-8800
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Provider Business Mailing Address
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Address Line | 97 CROSS ST
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City | WESTERLY
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State | RI
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Zip | 02891-2448
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Country | US
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Telephone | 401-596-8802
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Fax | 401-596-8800
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Authorized Official
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Title or Position | OWNER OPERATOR
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Name | ALEXIS TIANNA SCHONROG
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Credential | LICSW
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Telephone | 401-741-8206
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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 | ISW01848
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License Number State | RI
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