Provider Demographics
NPI:1235956509
Name:GUDIEL, NATALY MAITE (MSW)
Entity type:Individual
Prefix:
First Name:NATALY
Middle Name:MAITE
Last Name:GUDIEL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:NATALY
Other - Middle Name:MAITE
Other - Last Name:GUDIEL VARGAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:139 LAUREL HILL AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02909-4433
Mailing Address - Country:US
Mailing Address - Phone:401-286-4791
Mailing Address - Fax:
Practice Address - Street 1:55 HOPE ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2001
Practice Address - Country:US
Practice Address - Phone:401-331-1350
Practice Address - Fax:401-277-3385
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW038721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical