Healthcare Provider Details

I. General information

NPI: 1467600825
Provider Name (Legal Business Name): CARLY RIVERS LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 09/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2756 POST RD
WARWICK RI
02886-3003
US

IV. Provider business mailing address

2756 POST RD
WARWICK RI
02886-3003
US

V. Phone/Fax

Practice location:
  • Phone: 401-691-6000
  • Fax: 401-738-7718
Mailing address:
  • Phone: 401-691-6000
  • Fax: 401-738-7718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW01177
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW02086
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: