Provider Demographics
NPI:1376662601
Name:OSPINA, LUZ (LICSW)
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:
Last Name:OSPINA
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 1:100 MEDWAY ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4402
Mailing Address - Country:US
Mailing Address - Phone:401-421-4100
Mailing Address - Fax:401-454-5565
Practice Address - Street 1:100 MEDWAY ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4402
Practice Address - Country:US
Practice Address - Phone:401-421-4100
Practice Address - Fax:401-454-5565
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW 016221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI411912OtherBLUE CHIP
RI1021010OtherBEACON
RILO 47575Medicaid
RI27822-9OtherBLUE CROSS BLUE SHIELD
RI05-385696OtherTRICARE