Provider Demographics
NPI:1669157103
Name:SLADE, MERLIN (LCSW)
Entity type:Individual
Prefix:
First Name:MERLIN
Middle Name:
Last Name:SLADE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:MADELEINE
Other - Middle Name:
Other - Last Name:SLADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:43 GLOUCESTER ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-1407
Mailing Address - Country:US
Mailing Address - Phone:914-621-1731
Mailing Address - Fax:
Practice Address - Street 1:111 W GREENVILLE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:RI
Practice Address - Zip Code:02828-1510
Practice Address - Country:US
Practice Address - Phone:401-678-7079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical