MEDICARE: MS. JENNILL RACHELLI CORONADO LCSW

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	104100000X	Social Worker	CSW0216	RI

General Provider Information

NPI Number	:	1568167252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNILL RACHELLI CORONADO LCSW

Provider Business Mailing Address
First Line	:	321 AUBURN ST
Second Line	:
City	:	CRANSTON
State	:	RI
Zip	:	02910-3316
Country	:	US
Telephone Number	:	401-688-5493
Fax Number	:

Provider Business Practice Location Address
First Line	:	321 AUBURN ST
Second Line	:
City	:	CRANSTON
State	:	RI
Zip	:	02910-3316
Country	:	US
Telephone Number	:	401-688-5493
Fax Number	:

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

Provider Enumeration Date	:	04/03/2023
Last Update Date	:	04/03/2023

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