Provider Demographics
NPI:1306910419
Name:AHLIJANIAN, JENNIFER GREENE (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:GREENE
Last Name:AHLIJANIAN
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 FOREST HILLS DR
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:RI
Mailing Address - Zip Code:02822-2402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 CENTERVILLE RD STE 301S
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-0219
Practice Address - Country:US
Practice Address - Phone:401-732-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW002771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI406737OtherBLUE CHIP
RI62-15888OtherUBH
RIJG03354Medicaid
RI30109-7OtherBLUE CROSS RI