Provider Demographics
NPI:1689232456
Name:CRAVEN, MARY C (LICSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:CRAVEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:C
Other - Last Name:GALLAGHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18 PENTA ST
Mailing Address - Street 2:
Mailing Address - City:WEST WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02893-1421
Mailing Address - Country:US
Mailing Address - Phone:401-250-4080
Mailing Address - Fax:401-753-6716
Practice Address - Street 1:18 PENTA ST
Practice Address - Street 2:
Practice Address - City:WEST WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02893-1421
Practice Address - Country:US
Practice Address - Phone:401-250-4080
Practice Address - Fax:401-753-6716
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-05
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW034991041C0700X
RICSW02277101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health