Healthcare Provider Details

I. General information

NPI: 1154508257
Provider Name (Legal Business Name): RENEE J MCNEILLY LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 SNAKE HILL RD
N SCITUATE RI
02857-2919
US

IV. Provider business mailing address

315 SNAKE HILL RD
N SCITUATE RI
02857-2919
US

V. Phone/Fax

Practice location:
  • Phone: 401-497-4496
  • Fax:
Mailing address:
  • Phone: 401-497-4496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW02111
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: