Stacey Arruda-Tracy, LICSW
Individual provider Active NPI Clinical Social Worker · Pawtucket, RI
NPI 1215074208 · NPPES record last updated Apr 8, 2009
Key facts
- NPI
- 1215074208
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- ISW01891 (RI)
- Practice address
- 249 Roosevelt Ave
Suite 205
Pawtucket, RI 02860-2134 - Phone
- (401) 724-8400
- Fax
- (401) 365-1100
- NPI assigned
- Jan 31, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CSW00871 | RI | MD | Clinical Social Worker |
| ISW01891 | RI | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gateway Healthcare Inc | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | CSW00871 | RI | |
| Clinical Social Worker | 1041C0700X | ISW01891 | RI | Yes |
Addresses
Primary practice location
249 Roosevelt Ave
Suite 205
Pawtucket, RI 02860-2134
Mailing address
1516 Atwood Ave
Johnston, RI 02919-3223
Phone (401) 553-1031
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30343 | Other | RI | BLUE CROSS CRISIS |
| SA56205 | Medicaid | RI |
Other providers in Pawtucket, RI
- Armistice Primary Care, LLC
- Armistice Urgent Care & Occupational Health, Inc.
- Patricia Armitage
- Natalia Arraiol
- Jamy Arreola
- Michaela Arruda
- Arts, Sports, and Technology Resource Organization
- Farhan Ashraf
- Assisted Recovery,LLC
- Thomas Michael Atwood
All providers in Pawtucket, 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 Apr 8, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.