Carol Peloquin, LICSW
Individual provider Active NPI Clinical Social Worker · Johnston, RI
NPI 1194070508 · NPPES record last updated Dec 7, 2023
Key facts
- NPI
- 1194070508
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- LICSW125588 (MA)
- Practice address
- 1516 Atwood Ave
Johnston, RI 02919-3223 - Phone
- (401) 553-1000
- Fax
- (401) 553-1046
- NPI assigned
- Jul 23, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Southcoast Physicians Group Inc
Practice addresses (Care Compare)
101 Page St
New Bedford, MA 02740-3464
Phone (508) 973-5919
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231207000977 | MA | Practitioner - Clinical Social Worker | 6305109976 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LICSW125588 | MA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southcoast Physicians Group, Inc. | Current |
Accepting new patients | |
| Southcoast Physicians Group, Inc. | Current |
Accepting new patients | |
| Southcoast Physicians Group, Inc. | Current | Accepting new patients |
Locations
200 Mill Rd
Ste 180
Fairhaven, MA 02719
Phone (508) 973-2000
534 Prospect St
Fall River, MA 02720
Phone (508) 679-7766
101 Page St
New Bedford, MA 02740
Phone (508) 961-5425
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Clinical Social Worker | 1041C0700X | LICSW125588 | MA | Yes |
Addresses
Primary practice location
1516 Atwood Ave
Johnston, RI 02919-3223
Mailing address
1516 Atwood Ave
Johnston, RI 02919-3223
Phone (401) 553-1000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GH57134 | Medicaid | RI |
Other providers in Johnston, RI
- Minta Patel
- Patientfirst Transport Solutions LLC.
- Peerpoint Recovery Residences
- Olivia Rose Pellegrino
- Heather Lee Pelletier
- Sarah Peregrine
- Cheryl Lekhana Pereji
- Gail Pereschino
- Julia Perreault
- Kristen Marie Peters
All providers in Johnston, RI · Clinical Social Worker in Rhode Island
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.