=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861075491
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AUDREY MORONI LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2021
-----------------------------------------------------
Last Update Date | 05/02/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 469 CENTERVILLE RD
-----------------------------------------------------
City | WARWICK
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02886-4354
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-773-3700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30 FAIRWAY DR
-----------------------------------------------------
City | ATTLEBORO
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02703-2740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-644-1434
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | CSW02555
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------