MEDICARE: ALLISON HALL 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	ISW02054	RI

General Provider Information

NPI Number	:	1386336303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON HALL LICSW

Provider Business Mailing Address
First Line	:	439 BENEFIT ST
Second Line	:
City	:	PROVIDENCE
State	:	RI
Zip	:	02903-2934
Country	:	US
Telephone Number	:	401-262-0842
Fax Number	:

Provider Business Practice Location Address
First Line	:	439 BENEFIT ST
Second Line	:
City	:	PROVIDENCE
State	:	RI
Zip	:	02903-2934
Country	:	US
Telephone Number	:	401-262-0842
Fax Number	:

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

Provider Enumeration Date	:	05/26/2023
Last Update Date	:	05/26/2023

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