Provider Demographics
NPI:1720278062
Name:PALIOTTA, MICHELE DENISE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:DENISE
Last Name:PALIOTTA
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 1:1626 CRANSTON ST
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-5039
Mailing Address - Country:US
Mailing Address - Phone:401-868-0130
Mailing Address - Fax:401-944-4178
Practice Address - Street 1:1255 OAKLAWN AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-2649
Practice Address - Country:US
Practice Address - Phone:401-739-9787
Practice Address - Fax:401-739-9782
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW016111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI30946-8OtherBCBSRI
RI412941OtherBLUECHIP PLANS
RIMP54116Medicaid