Healthcare Provider Details

I. General information

NPI: 1841800604
Provider Name (Legal Business Name): WILCANIA BAEZ LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2020
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 CHALKSTONE AVE
PROVIDENCE RI
02908-4734
US

IV. Provider business mailing address

548 ROOSEVELT AVE APT 11
CENTRAL FALLS RI
02863-3218
US

V. Phone/Fax

Practice location:
  • Phone: 401-273-7100
  • Fax:
Mailing address:
  • Phone: 781-690-7661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number125451
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: