Provider Demographics
NPI:1538289640
Name:JOSEPHSON, ESME KATHARINE (MSW)
Entity Type:Individual
Prefix:MS
First Name:ESME
Middle Name:KATHARINE
Last Name:JOSEPHSON
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 1:74 ELMGROVE AVENUE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4135
Mailing Address - Country:US
Mailing Address - Phone:401-272-5429
Mailing Address - Fax:
Practice Address - Street 1:335 ANGELL STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4135
Practice Address - Country:US
Practice Address - Phone:401-274-5725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW014431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI26454-9Medicare UPIN
RI409-920Medicare UPIN