Individual
JEFFREY NOLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
520 HOPE ST, PROVIDENCE, RI 02906-2532
(401) 276-4155
Mailing address
528 N MAIN ST, PROVIDENCE, RI 02904-5757
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCDP00349
RI
1041C0700X
Clinical Social Worker
Primary
ISW00666
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30707-1
BLUE CROSS
RI
01
—
400154
BLUE CHIP
RI
01
—
62-28820
UNITED BEHAVIORAL HEALTH
RI
05
—
JN19771
—
RI
Enumeration date
06/28/2006
Last updated
07/08/2008
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