Individual
MR. DAVID JON MEDEIROS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
173 WATERMAN ST, PROVIDENCE, RI 02906-3919
(401) 743-1214
Mailing address
173 WATERMAN ST, PROVIDENCE, RI 02906-3919
(401) 743-1214
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
ISW01114
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20494-7
BLUECROSS
RI
01
—
409312
BLUECHIP
RI
Enumeration date
12/22/2006
Last updated
07/08/2007
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