Provider Demographics
NPI:1073964607
Name:CRETE, CLINTON C (MSW)
Entity Type:Individual
Prefix:MR
First Name:CLINTON
Middle Name:C
Last Name:CRETE
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 PECK HILL RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-5603
Mailing Address - Country:US
Mailing Address - Phone:401-533-4909
Mailing Address - Fax:
Practice Address - Street 1:108 PECK HILL RD
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-5603
Practice Address - Country:US
Practice Address - Phone:401-533-4909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW018551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical