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General NPI Number Information
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NPI Number | 1801244140
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Entity Type | Individual
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Provider Name | KELLIE MOREAU-WALSHE LICSW
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Gender | Female
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Dates
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Enumeration Date | 05/26/2016
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Last Update Date | 07/26/2019
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Provider Practice Location Address
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Address Line | 249 ROOSEVELT AVE
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City | PAWTUCKET
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State | RI
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Zip | 02860-2134
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Country | US
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Telephone | 401-724-8400
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Fax |
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Provider Business Mailing Address
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Address Line | 60 LIONEL AVE
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City | COVENTRY
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State | RI
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Zip | 02816-5945
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Country | US
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Telephone | 401-500-0598
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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 |
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License Number State |
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