Healthcare Provider Details

I. General information

NPI: 1174536510
Provider Name (Legal Business Name): CORY OLIVEIRA LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 04/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 ROCK ST
FALL RIVER MA
02720-3201
US

IV. Provider business mailing address

151 ROCK ST
FALL RIVER MA
02720-3201
US

V. Phone/Fax

Practice location:
  • Phone: 508-678-7542
  • Fax: 508-676-3699
Mailing address:
  • Phone: 508-678-7542
  • Fax: 508-676-3699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1025719
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: