MEDICARE: CLINICAL COUNSELING ASSOCIATES

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	ISW00936	RI

General Provider Information

NPI Number	:	1558488973
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICAL COUNSELING ASSOCIATES

Provider Business Mailing Address
First Line	:	2845 POST RD
Second Line	:	SUITE 113-114
City	:	WARWICK
State	:	RI
Zip	:	02886-3173
Country	:	US
Telephone Number	:	401-739-2425
Fax Number	:	401-846-8070

Provider Business Practice Location Address
First Line	:	2845 POST RD
Second Line	:	SUITE 113-114
City	:	WARWICK
State	:	RI
Zip	:	02886-3173
Country	:	US
Telephone Number	:	401-739-2425
Fax Number	:	401-846-8070

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. CHARLES W HEFFNER
Credential	:	PHD
Telephone Number	:	401-849-5600

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	07/22/2008

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