Provider Demographics
NPI:1053438705
Name:VARELA, KERRI-ANN SOARES (LICSW)
Entity type:Individual
Prefix:MRS
First Name:KERRI-ANN
Middle Name:SOARES
Last Name:VARELA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:KERRI-ANN
Other - Middle Name:SOARES
Other - Last Name:DAFANSECA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:52 HUMPHREY STREET
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914
Mailing Address - Country:US
Mailing Address - Phone:401-617-9366
Mailing Address - Fax:
Practice Address - Street 1:52 HUMPHREY ST
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-1115
Practice Address - Country:US
Practice Address - Phone:401-617-9366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW023461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1104847946OtherTHE PROVIDENCE CENTER NPI
RI1053438705OtherUBH