MEDICARE: MRS. ANNA M CARUOLO MSW

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	101YM0800X	Mental Health Counselor	ISW00413	RI

General Provider Information

NPI Number	:	1336298561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNA M CARUOLO MSW

Provider Business Mailing Address
First Line	:	170 DUGWAY BRIDGE RD
Second Line	:
City	:	WEST KINGSTON
State	:	RI
Zip	:	02892-1731
Country	:	US
Telephone Number	:	401-783-9121
Fax Number	:	401-782-4093

Provider Business Practice Location Address
First Line	:	170 DUGWAY BRIDGE RD
Second Line	:
City	:	WEST KINGSTON
State	:	RI
Zip	:	02892-1731
Country	:	US
Telephone Number	:	401-783-9121
Fax Number	:	401-782-4093

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	07/08/2007

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