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General NPI Number Information
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NPI Number | 1821714569
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Entity Type | Individual
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Provider Name | KRYSTAL AWILDA FERMIN LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/14/2022
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 180 CORLISS ST STE E1
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City | PROVIDENCE
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State | RI
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Zip | 02904-2602
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Country | US
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Telephone | 401-793-2928
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Fax |
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Provider Business Mailing Address
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Address Line | 22 MILO ST
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City | PROVIDENCE
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State | RI
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Zip | 02909-5950
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Country | US
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Telephone | 401-654-7197
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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 | ISW04423
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License Number State | RI
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