MEDICARE: LESLIE MORALES OLIVER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	ISW00708	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	254058	OTHER	RI	MAGELLAN HEALTH SERVICES
2	30667-2	OTHER	RI	RI BLUE CROSS BLUE SHIELD
3	406127	OTHER	RI	BLUE CHIP
4	050572443	OTHER	RI	UNITED HEALTHCARE; AETNA
5	1027350	OTHER	RI	NHPRI

General Provider Information

NPI Number	:	1114001393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE MORALES OLIVER

Provider Business Mailing Address
First Line	:	23 NORTH RD
Second Line	:	UNIT A-21
City	:	WAKEFIELD
State	:	RI
Zip	:	02879-2176
Country	:	US
Telephone Number	:	401-789-0810
Fax Number	:	401-364-0099

Provider Business Practice Location Address
First Line	:	23 NORTH RD
Second Line	:	UNIT A-21
City	:	WAKEFIELD
State	:	RI
Zip	:	02879-2176
Country	:	US
Telephone Number	:	401-789-0810
Fax Number	:	401-364-0099

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	06/23/2013

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Directions to “ LESLIE MORALES OLIVER ” Practice Location

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