Provider Demographics
NPI:1366506917
Name:WELITOFF, NORMA LYNNE (MSW,LICSW)
Entity type:Individual
Prefix:MS
First Name:NORMA
Middle Name:LYNNE
Last Name:WELITOFF
Suffix:
Gender:F
Credentials:MSW,LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 GRANDEVILLE CT APT 1037
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-8213
Mailing Address - Country:US
Mailing Address - Phone:401-378-7878
Mailing Address - Fax:401-294-3030
Practice Address - Street 1:1130 TEN ROD RD
Practice Address - Street 2:SUITE E 206B
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-4161
Practice Address - Country:US
Practice Address - Phone:401-378-7878
Practice Address - Fax:401-294-3030
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10311331041C0700X
RIISW012531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI345085OtherTRICARE
RI20904-5OtherBLUE CROSS BLUE SHIELD
RI1032500OtherNEIGHBORHOOD HEALTH PLAN
RINW48009Medicaid
RI62-25552Medicare UPIN