Healthcare Provider Details

I. General information

NPI: 1366955007
Provider Name (Legal Business Name): HEATHER CHILD QUERCIA LICSW AND LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2017
Last Update Date: 11/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 HARMONY HILL RD
CHEPACHET RI
02814-1429
US

IV. Provider business mailing address

PO BOX 64
EAST WOODSTOCK CT
06244-0064
US

V. Phone/Fax

Practice location:
  • Phone: 401-949-0690
  • Fax: 401-349-2028
Mailing address:
  • Phone: 860-576-3092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW02748
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: