Healthcare Provider Details

I. General information

NPI: 1447767140
Provider Name (Legal Business Name): LAUREN MEGAN BOTELHO LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2018
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 OREGON AVE
PAWTUCKET RI
02861-4244
US

IV. Provider business mailing address

195 OREGON AVE
PAWTUCKET RI
02861-4244
US

V. Phone/Fax

Practice location:
  • Phone: 774-240-3673
  • Fax:
Mailing address:
  • Phone: 774-240-3673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number125185
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: