Provider Demographics
NPI:1184352148
Name:IACOBUCCI, JANET ANN (CPD, CLC)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:ANN
Last Name:IACOBUCCI
Suffix:
Gender:F
Credentials:CPD, CLC
Other - Prefix:
Other - First Name:JAN
Other - Middle Name:ANN
Other - Last Name:IACOBUCCI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:35 NORMANDY DR
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-3113
Mailing Address - Country:US
Mailing Address - Phone:401-837-8564
Mailing Address - Fax:
Practice Address - Street 1:35 NORMANDY DR
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-3113
Practice Address - Country:US
Practice Address - Phone:401-837-8564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI201208374J00000X
RI374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula