Basic Information
| Provider Information | |||||||||
| NPI: | 1477894715 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GONCALVES | ||||||||
| FirstName: | TIRZA | ||||||||
| MiddleName: | |||||||||
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| Credential: | CSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 39 EAST AVE | ||||||||
| Address2: | |||||||||
| City: | PAWTUCKET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028604003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013129813 | ||||||||
| FaxNumber: | 4013120139 | ||||||||
| Practice Location | |||||||||
| Address1: | 39 EAST AVE | ||||||||
| Address2: | |||||||||
| City: | PAWTUCKET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028604003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013129813 | ||||||||
| FaxNumber: | 4013120139 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2013 | ||||||||
| LastUpdateDate: | 03/12/2013 | ||||||||
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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 | CSW01582 | RI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.