Individual
MR. HERMAN JASON FALU JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCDP
Contact information
Practice address
66 BURNETT ST, PROVIDENCE, RI 02907-2527
(401) 785-0050
(401) 941-0089
Mailing address
70 RUGBY ST, CRANSTON, RI 02910-4415
(401) 523-7520
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDP000495
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CDP000495
RHODE ISLAND DEPARTMENT OF HEALTH
RI
Enumeration date
04/16/2011
Last updated
04/16/2011
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