Provider Demographics
NPI:1104588953
Name:BITONDO, JOHN (LICSW)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BITONDO
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 1:232 MEDWAY ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5306
Mailing Address - Country:US
Mailing Address - Phone:401-484-8299
Mailing Address - Fax:
Practice Address - Street 1:232 MEDWAY ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5306
Practice Address - Country:US
Practice Address - Phone:401-484-8299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-08
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW044571041C0700X
CA1050021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical