Healthcare Provider Details

I. General information

NPI: 1083697551
Provider Name (Legal Business Name): CHARLENE LEVEILLEE CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 CENTERVILLE RD
WARWICK RI
02886-4394
US

IV. Provider business mailing address

15 OAKHURST AVE
WARWICK RI
02889-9003
US

V. Phone/Fax

Practice location:
  • Phone: 401-732-3332
  • Fax: 401-739-0196
Mailing address:
  • Phone: 401-739-2448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW01514
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: