Provider Demographics
NPI:1467411207
Name:STOCKWOOD, ALIX (LICSW)
Entity Type:Individual
Prefix:
First Name:ALIX
Middle Name:
Last Name:STOCKWOOD
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:PO BOX 603068
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-0068
Mailing Address - Country:US
Mailing Address - Phone:401-480-3434
Mailing Address - Fax:
Practice Address - Street 1:100 LAFAYETTE ST
Practice Address - Street 2:SUITE 103
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-6008
Practice Address - Country:US
Practice Address - Phone:401-480-3434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW002531041C0700X
MA10179531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1029030OtherNHP/BEACON
6230482OtherUNITED HEALTH
RIAS19612Medicaid
RI23622-9OtherBLUE CROSS BLUE SHIELD
409254OtherBLUE CHIP
6230482OtherUNITED HEALTH