Provider Demographics
NPI:1073796496
Name:EDOLO, CHRISTA (LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:
Last Name:EDOLO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-6306
Mailing Address - Country:US
Mailing Address - Phone:401-841-8896
Mailing Address - Fax:401-848-4192
Practice Address - Street 1:19 VALLEY RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-6306
Practice Address - Country:US
Practice Address - Phone:401-841-8896
Practice Address - Fax:401-848-4192
Is Sole Proprietor?:No
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILCSW009391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical