Individual
THOMAS MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
528 N MAIN ST, PROVIDENCE, RI 02904-5757
(401) 383-5811
Mailing address
528 N MAIN ST, PROVIDENCE, RI 02904-5757
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
CSW01571
RI
Other
Enumeration date
06/18/2012
Last updated
03/21/2014
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