Individual provider Active NPI

Deborah M Roberts, LICSW

  • Clinical Social Worker
  • South Kingstown, RI
National Provider Identifier
1457456857
Registry record updated Aug 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
ISW01460 Issued in RI
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, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 29, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
22762-0OtherRIBCBS

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111123000472 RI Practitioner - Clinical Social Worker 9537192422 Reassigns benefits to 2 organizations
Practice locations: Portsmouth, RI

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
Child and Family Psychiatry, Inc.Group PAC ID 5294173464, 90 clinicians

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

LicenseStateTypeSpecialty
LADC1MAMDAddiction (Substance Use Disorder) Counselor
110402MAMDClinical Social Worker
ISW01460RIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Newport County Community Mental Health Center, Inc CurrentSince Jan 11, 2021 Accepting new patients
Child and Family Psychiatry, Inc. Clinical CurrentSince Jun 15, 2024 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.

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

Verify at the official NPI Registry.