Jessica Reis-Driscoll, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

ISW01844 Issued in RI

Practice address

10 Elmgrove Ave Unit 1
Providence, RI 02906-4124

Phone

(401) 271-3689

NPI assigned

Mar 27, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Shine the Light Healing and Wellness

  • Clinical Social Worker
  • East Greenwich, RI
  • NPI 1114615952
  NPD Authorized official

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

{
    "created_epoch": "1427414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637107200000",
    "number": "1366836306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "873 WARWICK AVE FL 2",
            "city": "WARWICK",
            "state": "RI",
            "postal_code": "028883645",
            "telephone_number": "401-271-3689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 ELMGROVE AVE UNIT 1",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029064124",
            "telephone_number": "401-271-3689"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "873 Warwick Ave Fl 2",
            "address_purpose": "LOCATION",
            "city": "Warwick",
            "state": "RI",
            "postal_code": "028883645",
            "country_code": "US",
            "telephone_number": "401-271-3689",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REIS-DRISCOLL",
        "first_name": "JESSICA",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-03-27",
        "last_updated": "2021-11-17",
        "certification_date": "2021-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": "RI",
            "license": "ISW01844",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "RI",
            "license": "ISW01844",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen Reilly
• Kimberly Lynn Reilly, OT
• Lauren Elizabeth Reilly, DPT
• Daniella P Reimann, MD
• Danielle Reinker, PHARMD
• Paula Reisler, PA-C
• Antonio Emmanuel Reisopoulos, PA-C
• Ira H Reiter, PH.D.
• Charlotte A Rekrut, CRNA
• Amy Remillard, LCSW

• Clinical Social Worker in Providence, RI
• Providers in Providence, 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 Nov 17, 2021; 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.