Individual
JAMES GANNAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
520 HOPE ST, PROVIDENCE, RI 02906-2532
(401) 276-4000
Mailing address
951 N MAIN ST, PROVIDENCE, RI 02904-5759
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
ISW00664
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
24033-8
BLUE CROSS
RI
01
—
406403
BLUE CHIP
RI
01
—
62-19392
UNITED BEHAVIORAL HEALTH
RI
Enumeration date
06/19/2006
Last updated
07/08/2007
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