Shalissa Rose Coutoulakis, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW02399 Issued in RI

Practice address

304 Beverage Hill Ave
Pawtucket, RI 02861-4462

Phone

(401) 484-3012

NPI assigned

Mar 20, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1584662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584662400000",
    "number": "1164058202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 BEVERAGE HILL AVE",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028614462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 BEVERAGE HILL AVE",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028614462",
            "telephone_number": "401-484-3012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COUTOULAKIS",
        "first_name": "SHALISSA",
        "middle_name": "ROSE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-03-20",
        "last_updated": "2020-03-20",
        "certification_date": "2020-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "RI",
            "license": "CSW02399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Leigh Cotter, LICSW
• Jovante Cotto
• Patricia Coughenour, MD
• George C Cournoyer
• Paula C Coutinho
• Katrina Lynn Cox, M.S., R.D., LDN
• Vanessa Coyne, MASTERS
• Jill C Crawford
• Christopher James Crawley Jr.
• Donna Crawshaw, MASTERS

• Clinical Social Worker in Pawtucket, RI
• Providers in Pawtucket, 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 Mar 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.