Provider Demographics
NPI:1811022122
Name:GARIGLIO, GWENDOLYN (MSW)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:
Last Name:GARIGLIO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:GWENDOLYN
Other - Middle Name:
Other - Last Name:BRASSARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:153 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4011
Mailing Address - Country:US
Mailing Address - Phone:401-276-4300
Mailing Address - Fax:401-331-3285
Practice Address - Street 1:153 SUMMER ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4011
Practice Address - Country:US
Practice Address - Phone:401-276-4300
Practice Address - Fax:401-331-3285
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW017791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIGB52346Medicaid