Active NPI
Theresa A Beaudreau, LICSW
- Clinical Social Worker
- Providence, RI
National Provider Identifier
1427180397
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 00502
- Practice address
- 291 Waterman St
Providence, RI 02906-5130 - Phone
- (401) 274-9231
- NPI assigned
- Mar 9, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 00502 | RI | Primary |
Addresses
Primary practice location
291 Waterman St
Providence, RI 02906-5130
Mailing address
PO Box 8879
Cranston, RI 02920-0879
Phone (401) 572-3120
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2785 | Other | RI | BLUECROSS BLUESHIELD |
| 6254399 | Other | UNITED HEALTH | |
| 298567000 | Other | MAGELLAN | |
| TB63105 | Medicaid | RI | |
| 1036990 | Other | NEIGHBORHOOD HEALTH | |
| 408805 | Other | RI | BLUECHIP |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00502 | RI | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173398400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1305504000000",
"number": "1427180397",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 8879",
"city": "CRANSTON",
"state": "RI",
"postal_code": "029200879",
"telephone_number": "401-572-3120",
"fax_number": "401-572-3351"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "291 WATERMAN ST",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029065130",
"telephone_number": "401-274-9231"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEAUDREAU",
"first_name": "THERESA",
"middle_name": "A",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-09",
"last_updated": "2011-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "RI",
"license": "00502",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSS BLUESHIELD",
"identifier": "2785",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTH",
"identifier": "6254399",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN",
"identifier": "298567000",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "TB63105",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEIGHBORHOOD HEALTH",
"identifier": "1036990",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECHIP",
"identifier": "408805",
"state": "RI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Providence, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.