MEDICARE: NASRIN HAJIAN-BAHMANY 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	ISW01306	RI

General Provider Information

NPI Number	:	1619907441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NASRIN HAJIAN-BAHMANY LICSW

Provider Business Mailing Address
First Line	:	2 STREAM DRIVE
Second Line	:
City	:	CRANSTON
State	:	RI
Zip	:	02921
Country	:	US
Telephone Number	:	401-451-6603
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 STREAM DRIVE
Second Line	:
City	:	CRANSTON
State	:	RI
Zip	:	02921-2401
Country	:	US
Telephone Number	:	401-451-6603
Fax Number	:

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	09/28/2009

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