Provider Demographics
NPI:1457470759
Name:PINTO CABALLERO, GUISELA (LICSW)
Entity Type:Individual
Prefix:
First Name:GUISELA
Middle Name:
Last Name:PINTO CABALLERO
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 1:44 WESTCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02909-5529
Mailing Address - Country:US
Mailing Address - Phone:401-935-8493
Mailing Address - Fax:
Practice Address - Street 1:840 SMITHFIELD AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-3336
Practice Address - Country:US
Practice Address - Phone:401-935-8493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW 017561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1021010OtherBEACON
RI31345-6OtherBLUE CROSS BLUE SHIELD
RIGC 61581Medicaid
RI413410OtherBLUE CHIP