Provider Demographics
NPI:1740503671
Name:REARDON, JOSEPH (LICSW)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:REARDON
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 1:7 N MAIN ST STE 221
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-2246
Mailing Address - Country:US
Mailing Address - Phone:401-632-8163
Mailing Address - Fax:
Practice Address - Street 1:7 N MAIN ST STE 221
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-2246
Practice Address - Country:US
Practice Address - Phone:401-632-8163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-06
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1187091041C0700X
RIISW024671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical