Active NPI
Deborah M Roberts, LICSW
- Clinical Social Worker
- South Kingstown, RI
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- ISW01460
- Practice address
- 65 Village Square Dr Ste 302
South Kingstown, RI 02879-2569 - Phone
- (401) 785-0400
- NPI assigned
- Sep 13, 2006
- Last updated
- Aug 29, 2024
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | LADC1 | MA | |
| Clinical Social Worker | 1041C0700X | 110402 | MA | |
| Clinical Social Worker | 1041C0700X | ISW01460 | RI | Primary |
Addresses
Primary practice location
65 Village Square Dr Ste 302
South Kingstown, RI 02879-2569
Mailing address
PO Box 915
Portsmouth, RI 02871-0915
Phone (401) 743-3626
Other practice location 1
3047 E Main Rd
Ste 7B
Portsmouth, RI 02871-4262
Phone (401) 743-3626
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 22762-0 | Other | RI | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in RI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
65 Village Square Dr
Suite 302
South Kingstown, RI 02879-2569
Phone (401) 785-0040
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LADC1 | MA | MD | Addiction (Substance Use Disorder) Counselor |
| 110402 | MA | MD | Clinical Social Worker |
| ISW01460 | RI | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Newport County Community Mental Health Center, Inc | Current | Accepting new patients | |
| Child and Family Psychiatry, Inc. | Clinical | Current | Accepting new patients |
Locations
42 Valley Rd
Middletown, RI 02842
Phone (401) 843-1213
65 Valley Rd
Middletown, RI 02842
Phone 40184612131117
65 Village Square Dr
Ste 302
South Kingstown, RI 02879
Phone (877) 321-0922
1035 Post Rd
Warwick, RI 02888
Phone (401) 941-2830
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba LifeStance Health
- Psychiatry Physician
- Warwick, RI
- NPI 1760863229
Clinical
-
dba Newport Mental Health
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Middletown, RI
- NPI 1093713174
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158105600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724889600000",
"number": "1457456857",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 915",
"city": "PORTSMOUTH",
"state": "RI",
"postal_code": "028710915",
"telephone_number": "401-743-3626",
"fax_number": "401-683-0753"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "65 VILLAGE SQUARE DR STE 302",
"city": "SOUTH KINGSTOWN",
"state": "RI",
"postal_code": "028792569",
"telephone_number": "401-785-0400"
}
],
"practiceLocations": [
{
"address_1": "3047 E MAIN RD",
"address_2": "STE 7B",
"address_purpose": "LOCATION",
"city": "PORTSMOUTH",
"state": "RI",
"postal_code": "028714262",
"country_code": "US",
"telephone_number": "401-743-3626",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ROBERTS",
"first_name": "DEBORAH",
"middle_name": "M",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-13",
"last_updated": "2024-08-29",
"certification_date": "2024-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MA",
"license": "LADC1",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "110402",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "RI",
"license": "ISW01460",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "22762-0",
"state": "RI"
}
],
"endpoints": [],
"other_names": []
}
Other providers in South Kingstown, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.