Provider Demographics
NPI:1194857201
Name:DEPEYROT, JOELLE ANNE THERESE (LICSW)
Entity Type:Individual
Prefix:
First Name:JOELLE
Middle Name:ANNE THERESE
Last Name:DEPEYROT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 WATERMAN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4313
Mailing Address - Country:US
Mailing Address - Phone:401-753-4816
Mailing Address - Fax:
Practice Address - Street 1:205 WATERMAN ST STE 100
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4313
Practice Address - Country:US
Practice Address - Phone:401-753-4816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS238811041C0700X
MA1166721041C0700X
RIISW022061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
12334182OtherCAQH