Provider Demographics
NPI:1629318654
Name:VASCONCELOS, CATHRYN A (LCSW)
Entity Type:Individual
Prefix:
First Name:CATHRYN
Middle Name:A
Last Name:VASCONCELOS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1643 WARWICK AVE
Mailing Address - Street 2:#200
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02889-1525
Mailing Address - Country:US
Mailing Address - Phone:401-952-8188
Mailing Address - Fax:401-385-9410
Practice Address - Street 1:1643 WARWICK AVE
Practice Address - Street 2:#200
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02889-1525
Practice Address - Country:US
Practice Address - Phone:401-952-8188
Practice Address - Fax:401-385-9410
Is Sole Proprietor?:No
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW015191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical