Provider Demographics
NPI:1588001085
Name:JOHN E ANZIVINO
Entity Type:Organization
Organization Name:JOHN E ANZIVINO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:ANZIVINO
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, ACSW
Authorized Official - Phone:401-225-2224
Mailing Address - Street 1:12 SURREY DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-2073
Mailing Address - Country:US
Mailing Address - Phone:401-225-2224
Mailing Address - Fax:
Practice Address - Street 1:267 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-3750
Practice Address - Country:US
Practice Address - Phone:401-225-2224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW001231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty