Medeiros, David Jon

Medeiros, David Jon is an sole proprietor health care provider with primary practice located at 173 Waterman St , Providence RI 02906-3919. He recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as his primary health care specialty. Medeiros, David Jon can be contacted via phone (401) 743-1214.

Contact Information

Primary practice address
173 Waterman St Providence RI 02906-3919
Phone: (401) 743-1214
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X ISW01114 Rhode Island

Profile Details

NPI number 1336204072
LBN Legal business name Medeiros, David Jon
Credentials LICSW
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 22nd, 2006
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1336204072 NPPES
Rhode Island Other 409312 BLUECHIP
Rhode Island Other 20494-7 BLUECHIP

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