Madrone Bayan Phoenix, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW02055 Issued in RI

Practice address

1 Richmond SQ Ste 333C
Providence, RI 02906-5139

Phone

(401) 441-5834

NPI assigned

Sep 25, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Emdr & Somatic Psychotherapies of Rhode Island

  • Clinical Social Worker
  • Providence, RI
  • NPI 1912598046
  NPD Authorized official
• Phoenix Rising Centers LLC

  • Clinical Social Worker
  • Providence, RI
  • NPI 1376276832
  NPD Authorized official

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

{
    "created_epoch": "1506297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665619200000",
    "number": "1548779366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5",
            "city": "KINGSTON",
            "state": "RI",
            "postal_code": "028810005",
            "telephone_number": "401-441-5834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 RICHMOND SQ STE 333C",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029065139",
            "telephone_number": "401-441-5834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHOENIX",
        "first_name": "MADRONE",
        "middle_name": "BAYAN",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-09-25",
        "last_updated": "2022-10-13",
        "certification_date": "2022-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "RI",
            "license": "CSW02055",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maureen Phipps, MD
• Phousady C Phithayaphone, CCHW
• Phoenix Health Professional Group, LLC
• Phoenix Houses of New England, Inc.
• Phoenix Rising Centers LLC
• Matthew Phok, MSPT
• Chanika Phornphutkul, MD
• Sawpaka Phothisen
• Vanna Phrommavanh, LCSW
• Kimberly Pianucci, MD

• Clinical Social Worker in Providence, RI
• Providers in Providence, RI by specialty
• Clinical Social Worker in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.