Healthcare Provider Details

I. General information

NPI: 1205723558
Provider Name (Legal Business Name): COLLABORATIVE CARE NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2025
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 RICHMOND SQ STE 204
PROVIDENCE RI
02906-5135
US

IV. Provider business mailing address

2 RICHMOND SQ STE 204
PROVIDENCE RI
02906-5135
US

V. Phone/Fax

Practice location:
  • Phone: 401-206-0130
  • Fax:
Mailing address:
  • Phone: 401-206-0130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. FRAYNELIS Y ANDUJAR
Title or Position: CO-FOUNDER / CLINICIAN
Credential: LICSW
Phone: 401-749-4821