David Jon Medeiros, LICSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

ISW01114 Issued in RI

Practice address

173 Waterman St
Providence, RI 02906-3919

Phone

(401) 743-1214

NPI assigned

Dec 22, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1166745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1336204072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "173 WATERMAN ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029063919",
            "telephone_number": "401-743-1214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "173 WATERMAN ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029063919",
            "telephone_number": "401-743-1214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDEIROS",
        "first_name": "DAVID",
        "middle_name": "JON",
        "name_prefix": "Mr.",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "RI",
            "license": "ISW01114",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECHIP",
            "identifier": "409312",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS",
            "identifier": "20494-7",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Taylor Mealey, MD
• Meals on Wheels of Ri, Inc.
• Meals on Wheels of Ri, Inc.
• Elizabeth Moore Medbury, APRN
• Antone A Medeiros, MD
• Elizabeth Benevides Medeiros, PHARMD
• Gregg Allen Medeiros, D.C.
• Haley Melina Medeiros, COTA
• Julie Medeiros
• Kelsey Quinn Medeiros

• Mental Health Counselor in Providence, RI
• Providers in Providence, RI by specialty
• Mental Health Counselor in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.