Provider Demographics
NPI:1295811057
Name:GOLDIS, HAROLD (LICSW)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:
Last Name:GOLDIS
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:P.O. BOX 899
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-2222
Mailing Address - Country:US
Mailing Address - Phone:401-364-7705
Mailing Address - Fax:401-364-7705
Practice Address - Street 1:101 BACON ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-5542
Practice Address - Country:US
Practice Address - Phone:401-722-3560
Practice Address - Fax:401-722-3593
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI050306183OtherMULTIPLAN
RI050306183OtherMAGELLAN
RI233232OtherTRICARE
RI6234382OtherUBH
RIA007959OtherVALUE OPTIONS
RI1020890OtherBEACON NHP
RI306186OtherBCBS
RI406478OtherBLUE CHIP
RIHG13028Medicaid
RIRI0007930OtherCHAMPUS
RI050306183OtherMAGELLAN
RI007005316Medicare ID - Type UnspecifiedMEDICARE