Healthcare Provider Details

I. General information

NPI: 1023985041
Provider Name (Legal Business Name): JARELINE CORTES CHW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2025
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 REBEKAH ST
WOONSOCKET RI
02895-1121
US

IV. Provider business mailing address

26 REBEKAH ST
WOONSOCKET RI
02895-1121
US

V. Phone/Fax

Practice location:
  • Phone: 401-425-1000
  • Fax:
Mailing address:
  • Phone: 401-425-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number78975477
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: