Provider Demographics
NPI:1790149946
Name:GARZON, JOISE (LICSW)
Entity Type:Individual
Prefix:
First Name:JOISE
Middle Name:
Last Name:GARZON
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 1:331 BROADWAY UNIT 202
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02909-1101
Mailing Address - Country:US
Mailing Address - Phone:401-376-2363
Mailing Address - Fax:
Practice Address - Street 1:600 MOUNT PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-1940
Practice Address - Country:US
Practice Address - Phone:401-456-6320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-13
Last Update Date:2022-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW026081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1790149946OtherN/A