Provider Demographics
NPI:1235233693
Name:GLADDING, MARTHA W (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:W
Last Name:GLADDING
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MRS
Other - First Name:MARTHA
Other - Middle Name:W
Other - Last Name:PEDREIRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:67 VALLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-7218
Mailing Address - Country:US
Mailing Address - Phone:401-846-3422
Mailing Address - Fax:401-846-3419
Practice Address - Street 1:67 VALLEY ROAD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-7218
Practice Address - Country:US
Practice Address - Phone:401-846-3422
Practice Address - Fax:401-846-3419
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW000081041C0700X
MA1076281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI84242Medicare UPIN