Individual provider Active NPI

Andrea McDonald, LICSW

  • Clinical Social Worker
  • Riverside, RI
National Provider Identifier
1134645658
Registry record updated Jul 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
ISW02360 Issued in RI
Practice address
501 Wampanoag TRL Unit 400
Riverside, RI 02915-1507
Phone
(401) 785-0040
Fax
(401) 941-7847
NPI assigned
Aug 16, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 119603 MA
Clinical Social Worker 1041C0700X ISW02360 RI Primary

Addresses

Primary practice location

501 Wampanoag TRL Unit 400
Riverside, RI 02915-1507

Mailing address

42 Valley Rd
Middletown, RI 02842-6400
Phone (480) 495-1368

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250612000897 RI Practitioner - Clinical Social Worker 7618418849 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
119603MAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Newport County Community Mental Health Center, Inc CurrentSince Jan 30, 2025 Accepting new patients
Child and Family Psychiatry, Inc. Clinical CurrentSince Jul 1, 2025 Accepting new patients

Locations

42 Valley Rd
Middletown, RI 02842
Phone (401) 843-1213

65 Valley Rd
Middletown, RI 02842
Phone (401) 431-9870

501 Wampanoag Trl
Unit 400
Riverside, RI 02915
Phone (508) 207-8819

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1502841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753660800000",
    "number": "1134645658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42 VALLEY RD",
            "city": "MIDDLETOWN",
            "state": "RI",
            "postal_code": "028426400",
            "telephone_number": "480-495-1368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 WAMPANOAG TRL UNIT 400",
            "city": "RIVERSIDE",
            "state": "RI",
            "postal_code": "029151507",
            "telephone_number": "401-785-0040",
            "fax_number": "401-941-7847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCDONALD",
        "first_name": "ANDREA",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-16",
        "last_updated": "2025-07-28",
        "certification_date": "2025-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "119603",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "RI",
            "license": "ISW02360",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, RI

Sources for this page

Verify at the official NPI Registry.