Basic Information
| Provider Information | |||||||||
| NPI: | 1780752006 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STERN | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | |||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 HEALTH LN | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028862711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017384300 | ||||||||
| FaxNumber: | 4017388634 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 HEALTH LN | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028862711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017384300 | ||||||||
| FaxNumber: | 4017388634 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2006 | ||||||||
| LastUpdateDate: | 03/05/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | ISW01589 | RI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 31483-7 | 01 | RI | BLUE CROSS | OTHER | 1104847946 | 01 | RI | THE PROVIDENCE CENTER NPI | OTHER | 1386671535 | 01 | RI | THE KENT CENTER | OTHER | 413439 | 01 | RI | BLUE CHIP | OTHER | DS61496 | 05 | RI | MEDICAID | 62-16837 | 01 | RI | UNITED BEHAVIORAL HEALTH | OTHER |