Healthcare Provider Details

I. General information

NPI: 1255241634
Provider Name (Legal Business Name): GEORGE OTOOLE LCDP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 WAMPANOAG TRL
RIVERSIDE RI
02915-1504
US

IV. Provider business mailing address

641 POST RD
WARWICK RI
02888-1834
US

V. Phone/Fax

Practice location:
  • Phone: 401-500-6289
  • Fax:
Mailing address:
  • Phone: 401-431-9870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDP01102
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: