Samuel Wallace Peloquin, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

ISW023231 Issued in RI

Practice address

400 Massasoit Ave Ste 305
East Providence, RI 02914-2012

Phone

(401) 499-1043

NPI assigned

May 22, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Specialty

Clinical Social Worker

Education

Other, 2017

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Optum Behavioral Care of Connecticut, P.C.

  • Counseling Psychologist
  • East Providence, RI
  • NPI 1659152726
  NPD

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

{
    "created_epoch": "1653177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777507200000",
    "number": "1154069045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 MASSASOIT AVE STE 305",
            "city": "EAST PROVIDENCE",
            "state": "RI",
            "postal_code": "029142012",
            "telephone_number": "401-499-1043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 MASSASOIT AVE STE 305",
            "city": "EAST PROVIDENCE",
            "state": "RI",
            "postal_code": "029142012",
            "telephone_number": "401-499-1043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELOQUIN",
        "first_name": "SAMUEL",
        "middle_name": "WALLACE",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-05-22",
        "last_updated": "2026-04-30",
        "certification_date": "2026-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "RI",
            "license": "ISW03231",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "RI",
            "license": "ISW023231",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kinjal Patel, PT
• Pathways Therapy, LLC.
• Paula Silva, MSPT, LLC
• Valerie Pecchia, LICSW
• Pediatric Associates
• Kimberly Pennine
• Jessica Pepitone, MD
• Coyna Peralta Pena, LCSW
• Holly Nicole Pereira, MD
• Kelly M Pereira, OD

• Clinical Social Worker in East Providence, RI
• Providers in East Providence, RI by specialty
• Clinical Social Worker in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.