Provider Demographics
NPI:1881862423
Name:GOJCZ, CAROLINE IACONO (LICSW)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:IACONO
Last Name:GOJCZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:FLORENCE
Other - Last Name:IACONO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:555 N MAIN ST # 1326
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5722
Mailing Address - Country:US
Mailing Address - Phone:401-250-0079
Mailing Address - Fax:
Practice Address - Street 1:623 ATWELLS AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02909-7403
Practice Address - Country:US
Practice Address - Phone:401-273-3397
Practice Address - Fax:401-273-2021
Is Sole Proprietor?:No
Enumeration Date:2008-02-18
Last Update Date:2023-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
RIISW018791041C0700X, 101YM0800X
MA2124941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical