Healthcare Provider Details

I. General information

NPI: 1073558755
Provider Name (Legal Business Name): LORRAINE PEDRO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 PARK AVE
CRANSTON RI
02910-2346
US

IV. Provider business mailing address

521 PARK AVE
CRANSTON RI
02910-2346
US

V. Phone/Fax

Practice location:
  • Phone: 401-781-3374
  • Fax: 401-781-3376
Mailing address:
  • Phone: 401-781-3374
  • Fax: 401-781-3376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW1224
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: