Provider Demographics
NPI:1114135357
Name:STANFORD, DAVID JAMES (MSW, LICSW, LCDP II)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JAMES
Last Name:STANFORD
Suffix:
Gender:M
Credentials:MSW, LICSW, LCDP II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 WHITMAN ST
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-4901
Mailing Address - Country:US
Mailing Address - Phone:401-723-4397
Mailing Address - Fax:401-276-2723
Practice Address - Street 1:72 3RD ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2729
Practice Address - Country:US
Practice Address - Phone:401-276-2723
Practice Address - Fax:401-276-2723
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW017951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIISW01795OtherICSW