Provider Demographics
NPI:1780752006
Name:STERN, DAVID S (LICSW)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:STERN
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 1:50 HEALTH LN
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2711
Mailing Address - Country:US
Mailing Address - Phone:401-738-4300
Mailing Address - Fax:401-738-8634
Practice Address - Street 1:50 HEALTH LN
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2711
Practice Address - Country:US
Practice Address - Phone:401-738-4300
Practice Address - Fax:401-738-8634
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW015891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI31483-7OtherBLUE CROSS
RI1104847946OtherTHE PROVIDENCE CENTER NPI
RI1386671535OtherTHE KENT CENTER
RI413439OtherBLUE CHIP
RIDS61496Medicaid
RI62-16837OtherUNITED BEHAVIORAL HEALTH
RI1104847946OtherTHE PROVIDENCE CENTER NPI