Provider Demographics
NPI:1457601619
Name:IANNOTTI, ALBERT D JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:D
Last Name:IANNOTTI
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 CONCORD ST
Mailing Address - Street 2:SUITE 335
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-3477
Mailing Address - Country:US
Mailing Address - Phone:401-243-7456
Mailing Address - Fax:401-365-6860
Practice Address - Street 1:203 CONCORD ST
Practice Address - Street 2:SUITE 335
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-3477
Practice Address - Country:US
Practice Address - Phone:401-243-7456
Practice Address - Fax:401-365-6860
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW013391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RICSW01339OtherSOCIAL WORK LICENSE NUMBER