Provider Demographics
NPI:1790791358
Name:COLLIGNON, LOUIS J (LICSW)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:J
Last Name:COLLIGNON
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 TIVOLI CT
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-9117
Mailing Address - Country:US
Mailing Address - Phone:401-738-4300
Mailing Address - Fax:401-738-7718
Practice Address - Street 1:50 HEALTH LN
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2711
Practice Address - Country:US
Practice Address - Phone:401-738-4300
Practice Address - Fax:401-738-7718
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW005191041C0700X
MA1074461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI406379OtherBLUE CHIP
RILC03241Medicaid
RI62-48398OtherUBH
RI30128-4OtherBLUE CROSS