Healthcare Provider Details

I. General information

NPI: 1770005308
Provider Name (Legal Business Name): LESLIE K BRACKETT LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2017
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 MAPLE AVE # 291
BARRINGTON RI
02806-3560
US

IV. Provider business mailing address

18 MAPLE AVE # 291
BARRINGTON RI
02806-3560
US

V. Phone/Fax

Practice location:
  • Phone: 401-222-0267
  • Fax: 401-773-7106
Mailing address:
  • Phone: 401-222-0267
  • Fax: 401-245-0277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW02324
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: