Provider Demographics
NPI:1366641417
Name:GASPARD, CRAIG WARREN (LICSW)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:WARREN
Last Name:GASPARD
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 CHEROKEE DR
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-2911
Mailing Address - Country:US
Mailing Address - Phone:401-683-7828
Mailing Address - Fax:
Practice Address - Street 1:51 OLD MILL RD
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:RI
Practice Address - Zip Code:02813-3322
Practice Address - Country:US
Practice Address - Phone:401-364-1263
Practice Address - Fax:401-364-5220
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW011481041C0700X
MA10264281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical