Individual
GINA MARIE IACIOFANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
1445 WAMPANOAG TRL, SUITE 106, RIVERSIDE, RI 02915-1000
(401) 437-8844
Mailing address
697 WOODWARD RD, NORTH PROVIDENCE, RI 02904-3139
(401) 497-6500
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
ISW02121
RI
Other
Enumeration date
05/10/2011
Last updated
05/10/2011
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