Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | ISW02092 | RI |
NPI | 1003123498 |
---|---|
Provider Name | Mr. John Joseph Charette |
First Address | Pascoag, RI 02859-4001 |
Second Address | Pascoag, RI 02859-4001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2010 |
Last Update Date | 07/09/2010 |