Basic Information
| Provider Information | |||||||||
| NPI: | 1851996730 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRATAS | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 127 JOHNNY CAKE HILL RD | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028425674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018461213 | ||||||||
| FaxNumber: | 4018486394 | ||||||||
| Practice Location | |||||||||
| Address1: | 42 VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028426400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018461213 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2020 | ||||||||
| LastUpdateDate: | 01/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | CSW02512 | RI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.