Provider Demographics
NPI:1083697551
Name:LEVEILLEE, CHARLENE (CSW)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
Last Name:LEVEILLEE
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 OAKHURST AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02889-9003
Mailing Address - Country:US
Mailing Address - Phone:401-739-2448
Mailing Address - Fax:
Practice Address - Street 1:227 CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4394
Practice Address - Country:US
Practice Address - Phone:401-732-3332
Practice Address - Fax:401-739-0196
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW015141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI26895-8OtherBLUE CROSS PROVIDER NUMBE
RI411267OtherBLUE CHIP PROVIDER NUBER