Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | ISW01566 | RI |
NPI | 1003155904 |
---|---|
Provider Name | Andon Paul Joseph |
First Address | West Greenwich, RI 02817-2024 |
Second Address | West Greenwich, RI 02817-2024 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2013 |
Last Update Date | 12/02/2013 |