Healthcare Provider Details

I. General information

NPI: 1134040595
Provider Name (Legal Business Name): CORA LEE ANN CHARPENTIER CLSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 POINT JUDITH RD # 23
NARRAGANSETT RI
02882-3477
US

IV. Provider business mailing address

82 ROSLYN AVE
CRANSTON RI
02910-4117
US

V. Phone/Fax

Practice location:
  • Phone: 401-250-2731
  • Fax: 401-237-0988
Mailing address:
  • Phone: 401-256-2626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW04537
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: