Provider Demographics
NPI:1568167252
Name:CORONADO, JENNILL RACHELLI (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JENNILL
Middle Name:RACHELLI
Last Name:CORONADO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JENNILL
Other - Middle Name:RACHELLI
Other - Last Name:QUEZADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:321 AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-3316
Mailing Address - Country:US
Mailing Address - Phone:401-688-5493
Mailing Address - Fax:
Practice Address - Street 1:321 AUBURN ST
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-3316
Practice Address - Country:US
Practice Address - Phone:401-688-5493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW0216104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker