Organization
GINA M. IACIOFANO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GINA M IACIOFANO LICSW (CLINICAL SOCIAL WORKER)
(401) 497-6500
Entity
Organization
Contact information
Practice address
1920 MINERAL SPRING AVE, UNIT 9, NORTH PROVIDENCE, RI 02904-3742
(401) 497-6500
Mailing address
1920 MINERAL SPRING AVE, UNIT 9, NORTH PROVIDENCE, RI 02904-3742
(401) 497-6500
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
ISW02121
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002186701
MEDICARE
RI
05
—
GI84855
—
RI
Enumeration date
04/24/2012
Last updated
04/24/2012
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