Active NPI
Harold Goldis, LICSW
- Clinical Social Worker
- Pawtucket, RI
National Provider Identifier
1295811057
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Practice address
- 101 Bacon St
Pawtucket, RI 02860-5542 - Phone
- (401) 722-3560
- Fax
- (401) 722-3593
- NPI assigned
- Oct 27, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | |||
| Clinical Social Worker | 1041C0700X | Primary |
Addresses
Primary practice location
101 Bacon St
Pawtucket, RI 02860-5542
Mailing address
P.O. Box 899
Wakefield, RI 02879-2222
Phone (401) 364-7705
Other identifiers 10
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 050306183 | Other | RI | MULTIPLAN |
| 050306183 | Other | RI | MAGELLAN |
| 233232 | Other | RI | TRICARE |
| 6234382 | Other | RI | UBH |
| A007959 | Other | RI | VALUE OPTIONS |
| 1020890 | Other | RI | BEACON NHP |
| 306186 | Other | RI | BCBS |
| 406478 | Other | RI | BLUE CHIP |
| HG13028 | Medicaid | RI | |
| RI0007930 | Other | RI | CHAMPUS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161907200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1467936000000",
"number": "1295811057",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 899",
"city": "WAKEFIELD",
"state": "RI",
"postal_code": "028792222",
"telephone_number": "401-364-7705",
"fax_number": "401-364-7705"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 BACON ST",
"city": "PAWTUCKET",
"state": "RI",
"postal_code": "028605542",
"telephone_number": "401-722-3560",
"fax_number": "401-722-3593"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOLDIS",
"first_name": "HAROLD",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-27",
"last_updated": "2016-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MULTIPLAN",
"identifier": "050306183",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN",
"identifier": "050306183",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "233232",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UBH",
"identifier": "6234382",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "A007959",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BEACON NHP",
"identifier": "1020890",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "306186",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CHIP",
"identifier": "406478",
"state": "RI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "HG13028",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHAMPUS",
"identifier": "RI0007930",
"state": "RI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pawtucket, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.