Healthcare Provider Details

I. General information

NPI: 1679069652
Provider Name (Legal Business Name): LEANNA OLITSKY LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 11/06/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 W RIVER ST
PROVIDENCE RI
02904-2609
US

IV. Provider business mailing address

146 W RIVER ST
PROVIDENCE RI
02904-2609
US

V. Phone/Fax

Practice location:
  • Phone: 401-415-4200
  • Fax:
Mailing address:
  • Phone: 401-415-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW03037
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: