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General NPI Number Information
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NPI Number | 1427364736
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Entity Type | Individual
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Provider Name | ROBERTA L TVENSTRUP LICSW
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Gender | Female
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Dates
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Enumeration Date | 08/24/2010
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Last Update Date | 08/24/2010
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Provider Practice Location Address
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Address Line | 170 FAIRVIEW AVE
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City | COVENTRY
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State | RI
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Zip | 02816-7504
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Country | US
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Telephone | 401-486-7960
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Fax | 401-826-1858
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Provider Business Mailing Address
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Address Line | 21 AUDUBON LN
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City | HOPE
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State | RI
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Zip | 02831-1628
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Country | US
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Telephone | 401-486-7960
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Fax | 401-826-1858
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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 | ISW01155
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License Number State | RI
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