Basic Information
| Provider Information | |||||||||
| NPI: | 1003155904 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOSEPH | ||||||||
| FirstName: | ANDON | ||||||||
| MiddleName: | PAUL | ||||||||
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| Credential: | MSW, LICSW | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 90 PARKSIDE DR | ||||||||
| Address2: | |||||||||
| City: | WEST GREENWICH | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028172024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013859601 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 90 PARKSIDE DR | ||||||||
| Address2: | |||||||||
| City: | WEST GREENWICH | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028172024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013859601 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2013 | ||||||||
| LastUpdateDate: | 02/12/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | ISW01566 | RI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.