Provider Demographics
NPI:1619216488
Name:RHODES, CHRISTINE PASTORE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:PASTORE
Last Name:RHODES
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 1:1 RICHMOND SQ STE 219W-A
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5139
Mailing Address - Country:US
Mailing Address - Phone:774-231-8641
Mailing Address - Fax:401-633-6177
Practice Address - Street 1:1 RICHMOND SQ STE 219W-A
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5139
Practice Address - Country:US
Practice Address - Phone:774-231-8641
Practice Address - Fax:401-633-6177
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-13
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW022881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical