Healthcare Provider Details

I. General information

NPI: 1588757264
Provider Name (Legal Business Name): CAROLINE E OBRECHT MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 WAYLAND AVE
PROVIDENCE RI
02906
US

IV. Provider business mailing address

120 WAYLAND AVE
PROVIDENCE RI
02906
US

V. Phone/Fax

Practice location:
  • Phone: 401-273-7077
  • Fax:
Mailing address:
  • Phone: 401-273-7077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberISW01215
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: