=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386563534
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | OPHELIA WILLOW RAVENIA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2026
-----------------------------------------------------
Last Update Date | 07/13/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 45 SCHOOL ST
-----------------------------------------------------
City | TAUNTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02780-3222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-568-8856
-----------------------------------------------------
Fax | 508-219-6941
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 441 SMITHFIELD AVE APT 3
-----------------------------------------------------
City | PAWTUCKET
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02860-2551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-378-5841
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | CSW04114
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------