Provider Demographics
NPI:1487665816
Name:BAXENDALE, JEAN MARGARET (MSW)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:MARGARET
Last Name:BAXENDALE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 WAMPANOAG TRAIL
Mailing Address - Street 2:SUITE 205
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915
Mailing Address - Country:US
Mailing Address - Phone:401-433-4242
Mailing Address - Fax:
Practice Address - Street 1:1445 WAMPANOAG TRAIL
Practice Address - Street 2:SUITE 205
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915
Practice Address - Country:US
Practice Address - Phone:401-433-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW003071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI37547OtherRI BLUE CROSS
RI102470OtherBEACON HEALTH
593878Medicare UPIN