1053438705 NPI number — MRS. KERRI-ANN SOARES VARELA LICSW

Table of content: (NPI 1265558118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053438705 NPI number — MRS. KERRI-ANN SOARES VARELA LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VARELA
Provider First Name:
KERRI-ANN
Provider Middle Name:
SOARES
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAFANSECA
Provider Other First Name:
KERRI-ANN
Provider Other Middle Name:
SOARES
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LICSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1053438705
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
52 HUMPHREY STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-617-9366
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
52 HUMPHREY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02914-1115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-617-9366
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  ISW02346 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1104847946 . This is a "THE PROVIDENCE CENTER NPI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 1053438705 . This is a "UBH" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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