Provider Demographics
NPI:1225583909
Name:MAMBRO, LINDA (LICSW)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:MAMBRO
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 1:1645 WARWICK AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02889-1524
Mailing Address - Country:US
Mailing Address - Phone:401-865-9582
Mailing Address - Fax:401-329-3893
Practice Address - Street 1:1645 WARWICK AVE STE 203
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02889-1524
Practice Address - Country:US
Practice Address - Phone:401-865-9582
Practice Address - Fax:401-329-3893
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-23
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW033331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical