Provider Demographics
NPI:1679069652
Name:OLITSKY, LEANNA (LICSW)
Entity Type:Individual
Prefix:
First Name:LEANNA
Middle Name:
Last Name:OLITSKY
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 1:146 W RIVER ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-2609
Mailing Address - Country:US
Mailing Address - Phone:401-415-4200
Mailing Address - Fax:
Practice Address - Street 1:146 W RIVER ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-2609
Practice Address - Country:US
Practice Address - Phone:401-415-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW030371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical