Provider Demographics
NPI:1346386646
Name:GIORDANO, BARRY JOHN (MED MSSS LICSW)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:JOHN
Last Name:GIORDANO
Suffix:
Gender:M
Credentials:MED MSSS LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 KNOLL CREST DRIVE
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864
Mailing Address - Country:US
Mailing Address - Phone:401-658-0867
Mailing Address - Fax:
Practice Address - Street 1:30 MAN MAR DRIVE
Practice Address - Street 2:SUITE 7
Practice Address - City:PLAINVILLE
Practice Address - State:MA
Practice Address - Zip Code:02762
Practice Address - Country:US
Practice Address - Phone:508-699-9417
Practice Address - Fax:508-699-2127
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005106104100000X
MA102491104100000X
RIISW00021104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP02468Medicare ID - Type Unspecified