Provider Demographics
NPI:1235276395
Name:BANDONI, CHRISTINE MILLER (LICSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MILLER
Last Name:BANDONI
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 1:2091 MAIN RD
Mailing Address - Street 2:
Mailing Address - City:TIVERTON
Mailing Address - State:RI
Mailing Address - Zip Code:02878-4607
Mailing Address - Country:US
Mailing Address - Phone:401-842-1621
Mailing Address - Fax:
Practice Address - Street 1:10 KING CHARLES DR.
Practice Address - Street 2:BLDG. 100 SUITE 107
Practice Address - City:PORTSMOUTH
Practice Address - State:RI
Practice Address - Zip Code:02871
Practice Address - Country:US
Practice Address - Phone:401-683-2026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW017841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical