Provider Demographics
NPI:1033324355
Name:RAINEY, JESSICA FAY (LICSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:FAY
Last Name:RAINEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:889 CENTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4342
Mailing Address - Country:US
Mailing Address - Phone:401-821-4100
Mailing Address - Fax:401-823-9180
Practice Address - Street 1:889 CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4342
Practice Address - Country:US
Practice Address - Phone:401-821-4100
Practice Address - Fax:401-823-9180
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW017491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0000031210OtherRI BLUE CROSS PROVIDER #
RI413318OtherRI BLUE CHIP PROVIDER #