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General NPI Number Information
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NPI Number | 1073252508
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Entity Type | Individual
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Provider Name | KRISTINA ELIZABETH LEITE MSW
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Gender | Female
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Dates
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Enumeration Date | 06/02/2022
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Last Update Date | 06/07/2022
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Provider Practice Location Address
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Address Line | 205 WATERMAN ST # 202
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City | PROVIDENCE
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State | RI
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Zip | 02906-4313
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Country | US
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Telephone | 401-433-9812
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Fax |
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Provider Business Mailing Address
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Address Line | 61 DALTON ST # 2R
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City | RUMFORD
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State | RI
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Zip | 02916-2803
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Country | US
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Telephone | 401-744-3332
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ISW01058
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License Number State | RI
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