Provider Demographics
NPI:1801935648
Name:PLOTKIN, JUEL H (LICSW)
Entity type:Individual
Prefix:MRS
First Name:JUEL
Middle Name:H
Last Name:PLOTKIN
Suffix:
Gender:F
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:PO BOX 172
Mailing Address - Street 2:
Mailing Address - City:PEACE DALE
Mailing Address - State:RI
Mailing Address - Zip Code:02883-0172
Mailing Address - Country:US
Mailing Address - Phone:401-783-6438
Mailing Address - Fax:
Practice Address - Street 1:24 SALT POND RD
Practice Address - Street 2:#B4
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-4314
Practice Address - Country:US
Practice Address - Phone:401-783-1310
Practice Address - Fax:401-783-7596
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1070901041S0200X
RIISW007331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool