Provider Demographics
NPI:1710577234
Name:WINTERBOTTOM, JOANNA L (LICSW)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:L
Last Name:WINTERBOTTOM
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 1:1075 SMITH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-2700
Mailing Address - Country:US
Mailing Address - Phone:401-369-9224
Mailing Address - Fax:
Practice Address - Street 1:1075 SMITH ST STE 2
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-2700
Practice Address - Country:US
Practice Address - Phone:401-369-9224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW03841104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker