MEDICARE: MS. JEAN M BAHRMAN LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LICSW ISW01969	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1351737	OTHER	NY	AETNA INSURANCE

General Provider Information

NPI Number	:	1023176948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JEAN M BAHRMAN LICSW

Provider Business Mailing Address
First Line	:	PO BOX 217
Second Line	:
City	:	BARRINGTON
State	:	RI
Zip	:	02806-0217
Country	:	US
Telephone Number	:	401-864-2088
Fax Number	:

Provider Business Practice Location Address
First Line	:	380 JEFFERSON BLVD
Second Line	:	SUITE D
City	:	WARWICK
State	:	RI
Zip	:	02886-1356
Country	:	US
Telephone Number	:	401-864-2088
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	04/13/2009

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Directions to “ MS. JEAN M BAHRMAN LICSW” Practice Location

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