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General NPI Number Information
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NPI Number | 1124776695
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Entity Type | Individual
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Provider Name | COLLEEN MARY DUSEL LICSW
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Gender | Female
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Dates
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Enumeration Date | 03/14/2022
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Last Update Date | 03/14/2022
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Provider Practice Location Address
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Address Line | 1992 OLD LOUISQUISSET PIKE
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City | LINCOLN
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State | RI
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Zip | 02865-4590
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Country | US
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Telephone | 401-475-0653
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Fax | 401-475-0729
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Provider Business Mailing Address
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Address Line | 116 WAVERLY RD
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City | LUDLOW
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State | MA
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Zip | 01056-1618
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Country | US
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Telephone | 413-588-1560
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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 | ISW03504
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License Number State | RI
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