Individual
MR. JEREMY THAYER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
426 SCRABBLETOWN RD, NORTH KINGSTOWN, RI 02852-2001
(401) 829-3355
(401) 667-2733
Mailing address
452 GARDINER RD, WEST KINGSTON, RI 02892-1068
(401) 829-3355
(401) 667-2733
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
CSW00983
RI
1041C0700X
Clinical Social Worker
ISW01934
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
JT59949
—
RI
Enumeration date
02/27/2007
Last updated
06/13/2022
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