Individual
MR. THEODORE WILLIAM BLICKWEDEL II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW, LICSW
Contact information
Practice address
1395 ATWOOD AVE STE 201, JOHNSTON, RI 02919-4931
(401) 383-7633
(877) 266-4503
Mailing address
1395 ATWOOD AVE STE 201, JOHNSTON, RI 02919-4931
(401) 383-7633
(877) 266-4503
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
ISW02141
RI
Other
Enumeration date
10/02/2018
Last updated
10/02/2018
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