Healthcare Provider Details

I. General information

NPI: 1013631803
Provider Name (Legal Business Name): WILMER URENA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2022
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 JOB ST
PROVIDENCE RI
02904-1527
US

IV. Provider business mailing address

51 JOB ST
PROVIDENCE RI
02904-1527
US

V. Phone/Fax

Practice location:
  • Phone: 401-204-3489
  • Fax:
Mailing address:
  • Phone: 401-204-3489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLICSW1141192
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW04380
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: