Active NPI
Susan Elizabeth Soares, MSW
- Clinical Social Worker
- Dayville, CT
National Provider Identifier
1457387557
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 004957
- Practice address
- 1007 N Main St
Dayville, CT 06241-2170 - Phone
- (860) 774-2020
- Fax
- (860) 779-5436
- NPI assigned
- Jun 23, 2006
- Last updated
- Jun 19, 2012
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | ISW01165 | RI | |
| Clinical Social Worker | 1041C0700X | 004957 | CT | Primary |
Addresses
Primary practice location
1007 N Main St
Dayville, CT 06241-2170
Mailing address
1007 N Main St
PO Box 839
Dayville, CT 06241-2170
Phone (860) 774-2020
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 62-94720 | Other | RI | UNITED BEHAVIORAL HEALTH |
| 411734 | Other | RI | BLUE CHIP |
| SS51562 | Medicaid | RI | |
| 27207-6 | Other | RI | BLUE CROSS |
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 |
|---|---|---|---|
| ISW01165 | RI | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151020800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340064000000",
"number": "1457387557",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1007 N MAIN ST",
"address_2": "PO BOX 839",
"city": "DAYVILLE",
"state": "CT",
"postal_code": "062412170",
"telephone_number": "860-774-2020",
"fax_number": "860-779-5436"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1007 N MAIN ST",
"city": "DAYVILLE",
"state": "CT",
"postal_code": "062412170",
"telephone_number": "860-774-2020",
"fax_number": "860-779-5436"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOARES",
"first_name": "SUSAN",
"middle_name": "ELIZABETH",
"name_prefix": "Mrs.",
"credential": "MSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-23",
"last_updated": "2012-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "RI",
"license": "ISW01165",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CT",
"license": "004957",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED BEHAVIORAL HEALTH",
"identifier": "62-94720",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CHIP",
"identifier": "411734",
"state": "RI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "SS51562",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "27207-6",
"state": "RI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dayville, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.