Healthcare Provider Details

I. General information

NPI: 1821119322
Provider Name (Legal Business Name): ANTHONY JOSEPH TARABORELLI LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 SOCIAL ST STE 740
WOONSOCKET RI
02895-3216
US

IV. Provider business mailing address

PO BOX 1329
WOONSOCKET RI
02895-0839
US

V. Phone/Fax

Practice location:
  • Phone: 401-829-8838
  • Fax: 401-769-1930
Mailing address:
  • Phone: 401-829-8838
  • Fax: 401-769-1930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW01626
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: