| Gina M. Iaciofano, Llc | |
|
1920 Mineral Spring Ave Unit 9 North Providence RI 02904-3742 | |
| (401) 497-6500 | |
| Not Available |
| Full Name | Gina M. Iaciofano, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1920 Mineral Spring Ave, North Providence, Rhode Island |
| Authorized Official Name and Position | Gina M Iaciofano (CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 4014976500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gina M. Iaciofano, Llc 1920 Mineral Spring Ave Unit 9 North Providence RI 02904-3742 Ph: (401) 497-6500 | Gina M. Iaciofano, Llc 1920 Mineral Spring Ave Unit 9 North Providence RI 02904-3742 Ph: (401) 497-6500 |
| NPI Number | 1437417839 |
|---|---|
| Provider Enumeration Date | 04/24/2012 |
| Last Update Date | 04/24/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437417839 | NPI | - | NPPES |
| 002186701 | Other | RI | MEDICARE |
| GI84855 | Medicaid | RI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | ISW02121 (Rhode Island) | Primary |
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