Active NPI
Vidal P Perez, MSW
- Clinical Social Worker
- Providence, RI
National Provider Identifier
1467462291
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- ISW 00915
- Practice address
- 645 Elmwood Ave
Providence, RI 02907-3313 - Phone
- (401) 467-8094
- Fax
- (401) 467-8857
- NPI assigned
- Aug 8, 2006
- Sex
- Male
- 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 | ISW 00915 | RI | Primary |
Addresses
Primary practice location
645 Elmwood Ave
Providence, RI 02907-3313
Mailing address
645 Elmwood Ave
Providence, RI 02907-3313
Phone (401) 467-8094
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1021380 | Other | RI | NHP RI PROVIDER NUMBER |
| 6251061 | Other | RI | UBH PROVIDER NUMBER |
| 21072-4 | Other | RI | BC/BS PROVIDER NUMBER |
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 |
|---|---|---|---|
| ISW 00915 | RI | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154995200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1331856000000",
"number": "1467462291",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "645 ELMWOOD AVE",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029073313",
"telephone_number": "401-467-8094",
"fax_number": "401-467-8857"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "645 ELMWOOD AVE",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029073313",
"telephone_number": "401-467-8094",
"fax_number": "401-467-8857"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEREZ",
"first_name": "VIDAL",
"middle_name": "P",
"name_prefix": "Mr.",
"credential": "MSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-08",
"last_updated": "2012-03-16",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "RI",
"license": "ISW 00915",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NHP RI PROVIDER NUMBER",
"identifier": "1021380",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UBH PROVIDER NUMBER",
"identifier": "6251061",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS PROVIDER NUMBER",
"identifier": "21072-4",
"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 Mar 16, 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.