Provider Demographics
NPI:1588926364
Name:DEMAIO, ANANDA DAY (LICSW)
Entity type:Individual
Prefix:
First Name:ANANDA
Middle Name:DAY
Last Name:DEMAIO
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 1:345 BLACKSTONE BLVD STE 127
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4800
Mailing Address - Country:US
Mailing Address - Phone:401-455-6528
Mailing Address - Fax:401-455-6494
Practice Address - Street 1:345 BLACKSTONE BLVD STE 127
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4800
Practice Address - Country:US
Practice Address - Phone:401-455-6528
Practice Address - Fax:401-455-6494
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW027511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical