Provider Demographics
NPI:1083356604
Name:SERABIAN, LOGAN (LCSW)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:
Last Name:SERABIAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 MARBLEHEAD AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-4240
Mailing Address - Country:US
Mailing Address - Phone:401-787-1451
Mailing Address - Fax:
Practice Address - Street 1:2348 POST RD STE 107
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2271
Practice Address - Country:US
Practice Address - Phone:401-787-1451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW02717104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker