Basic Information
| Provider Information | |||||||||
| NPI: | 1184795817 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GIORDANO | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | W. | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 71 PRINCETON AVE | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029071501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013313188 | ||||||||
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| Practice Location | |||||||||
| Address1: | 50 HEALTH LN | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028862711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017384300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | ISW01646 | RI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | CG54818 | 05 | RI | MEDICAID | 412377 | 01 | RI | BLUE CHIP | OTHER | 29318-3 | 01 | RI | BLUE CROSS | OTHER |