Basic Information
| Provider Information | |||||||||
| NPI: | 1881862423 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOJCZ | ||||||||
| FirstName: | CAROLINE | ||||||||
| MiddleName: | IACONO | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LICSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | IACONO | ||||||||
| OtherFirstName: | CAROLINE | ||||||||
| OtherMiddleName: | FLORENCE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LICSW | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 24 SCHOOL ST | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028403144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018492300 | ||||||||
| FaxNumber: | 4018484156 | ||||||||
| Practice Location | |||||||||
| Address1: | 623 ATWELLS AVE | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029097403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4012733397 | ||||||||
| FaxNumber: | 4012732021 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2008 | ||||||||
| LastUpdateDate: | 02/18/2008 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | ISW01879 | RI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 212494 | MA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.