Healthcare Provider Details

I. General information

NPI: 1700119062
Provider Name (Legal Business Name): DEBORAH E CARRANZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH E HUGHES-CARRANZA

II. Dates (important events)

Enumeration Date: 09/17/2009
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 ELLENFIELD ST SUITE 101
PROVIDENCE RI
02905-4513
US

IV. Provider business mailing address

164 SUMMIT AVE
PROVIDENCE RI
02906-2853
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-6779
  • Fax:
Mailing address:
  • Phone: 401-793-4300
  • Fax: 401-793-4312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number01121
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: