Provider Demographics
NPI:1053907428
Name:GORETAYA, SVETLANA (LCSW)
Entity type:Individual
Prefix:
First Name:SVETLANA
Middle Name:
Last Name:GORETAYA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3495 POST RD APT 106
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-7116
Mailing Address - Country:US
Mailing Address - Phone:401-282-9221
Mailing Address - Fax:
Practice Address - Street 1:35 SOUTH COUNTY COMMONS WAY
Practice Address - Street 2:2ND FLOOR, SUITE D8-1
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879
Practice Address - Country:US
Practice Address - Phone:401-282-9221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW022501041C0700X
RIISW03644101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical