Provider Demographics
NPI:1376779751
Name:AMOROSO, KRYSTAL ALVES (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:ALVES
Last Name:AMOROSO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:BETTENCOURT
Other - Last Name:ALVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:46 N HULL ST
Mailing Address - Street 2:APT 1
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-2631
Mailing Address - Country:US
Mailing Address - Phone:401-573-7551
Mailing Address - Fax:
Practice Address - Street 1:410 N BROADWAY
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-2025
Practice Address - Country:US
Practice Address - Phone:401-434-4920
Practice Address - Fax:401-434-4920
Is Sole Proprietor?:No
Enumeration Date:2009-05-30
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW020871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical