Provider Demographics
NPI:1962452276
Name:DECONTI, LINDA ANN (LICSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:ANN
Last Name:DECONTI
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 1:275 GROTTO AVE
Mailing Address - Street 2:UNIT 20
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-3400
Mailing Address - Country:US
Mailing Address - Phone:401-724-5184
Mailing Address - Fax:
Practice Address - Street 1:33 COLLEGE HILL RD
Practice Address - Street 2:SUITE 30E
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2776
Practice Address - Country:US
Practice Address - Phone:401-821-6070
Practice Address - Fax:401-821-6047
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW001831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI3293-5OtherBC/BS OF RI
62-54367OtherUNITED BEHAVIORAL HEALTH
RI7005282Medicaid
62-54367OtherUNITED HEALTH CARE
406340OtherBLUECHIP
13534OtherCIGNA