| Denise M Fragoza Licsw,lcdp,ccjp | |
|
654 Metacom Ave Warren RI 02885-2300 | |
| (401) 245-5395 | |
| (401) 245-5395 |
| Full Name | Denise M Fragoza Licsw,lcdp,ccjp |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 654 Metacom Ave, Warren, Rhode Island |
| Authorized Official Name and Position | Denise Marie Fragoza (CLINCAL DIRECTOR) |
| Authorized Official Contact | 4012455395 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Denise M Fragoza Licsw,lcdp,ccjp 34 2nd St Swansea MA 02777-3203 Ph: (508) 324-5282 | Denise M Fragoza Licsw,lcdp,ccjp 654 Metacom Ave Warren RI 02885-2300 Ph: (401) 245-5395 |
| NPI Number | 1154348803 |
|---|---|
| Provider Enumeration Date | 07/17/2006 |
| Last Update Date | 07/09/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154348803 | NPI | - | NPPES |
| CB30596 | Medicaid | RI | |
| DF04200 | Medicaid | RI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | CDP00146 (Rhode Island) | Secondary |
| 1041C0700X | Social Worker - Clinical | ISW00719 (Rhode Island) | Primary |
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