Individual provider Active NPI

Kristina Harriott Lavoie, LCSW

  • Clinical Social Worker
  • Pawtucket, RI
National Provider Identifier
1487986881
Registry record updated Feb 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
CSW01299 Issued in RI
Practice address
82 Pond St
Pawtucket, RI 02860-4462
Phone
(401) 724-8400
Fax
(401) 722-5039
NPI assigned
Feb 10, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X CSW01299 RI Primary

Addresses

Primary practice location

82 Pond St
Pawtucket, RI 02860-4462

Mailing address

82 Pond St
Pawtucket, RI 02860-4462
Phone (401) 724-8400

Other identifiers 1

IdentifierTypeStateIssuer
GH57134MedicaidRI

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
I20140909000410 RI Practitioner - Clinical Social Worker 4789803636 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CSW01299RIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Prospect Chartercare RWMC, LLC CurrentSince Apr 15, 2019 Accepting new patients
Gateway Healthcare Inc CurrentSince Oct 8, 2013 Accepting new patients
Prospect Chartercare RWMC, LLC Clinical CurrentSince Apr 15, 2019 Accepting new patients
Prospect Chartercare Sjhsri, LLC CurrentSince Apr 15, 2019 Accepting new patients
Prospect Chartercare Sjhsri, LLC CurrentSince Apr 15, 2019 Accepting new patients

Locations

1516 Atwood Ave
Johnston, RI 02919
Phone (401) 463-8829

2 Wake Robin Rd
Lincoln, RI 02865
Phone (401) 333-1747

200 High Service Ave
North Providence, RI 02904
Phone (401) 456-3000

249 Roosevelt Ave
Ste 206
Pawtucket, RI 02860

1 Virginia Ave
Ste 200
Providence, RI 02905

825 Chalkstone Ave
Providence, RI 02908
Phone (401) 456-2000

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1265760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1265760000000",
    "number": "1487986881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "82 POND ST",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028604462",
            "telephone_number": "401-724-8400",
            "fax_number": "401-722-5039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "82 POND ST",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028604462",
            "telephone_number": "401-724-8400",
            "fax_number": "401-722-5039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAVOIE",
        "first_name": "KRISTINA",
        "middle_name": "HARRIOTT",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-02-10",
        "last_updated": "2010-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "RI",
            "license": "CSW01299",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GH57134",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pawtucket, RI

Sources for this page

Verify at the official NPI Registry.