Individual provider Active NPI

Josefa Nicole Vidal, LCSW

  • Clinical Social Worker
  • Cranston, RI
National Provider Identifier
1558079475
Registry record updated Dec 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
1090 Cranston St
Cranston, RI 02920-7323
Phone
(401) 781-3990
Fax
(401) 223-0121
NPI assigned
Nov 9, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2025

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 RI Primary

Addresses

Primary practice location

1090 Cranston St
Cranston, RI 02920-7323

Mailing address

12 Maplewood Ave FL 1
Cranston, RI 02920-7023
Phone (401) 209-7094

Other practice location 1

49 Westfield St Ste 14
Providence, RI 02907-2593
Phone (401) 209-7094

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL NextGen

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
I20221230000819 RI Practitioner - Clinical Social Worker 6305216755 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Comprehensive Community Action, Inc CurrentSince Nov 14, 2022 Accepting new patients
Comprehensive Community Action, Inc. CurrentSince Nov 14, 2022 Accepting new patients

Locations

311 Doric Ave
Cranston, RI 02910
Phone (401) 467-9610

1090 Cranston St
Cranston, RI 02920
Phone (401) 467-9610

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1667952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766361600000",
    "number": "1558079475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 MAPLEWOOD AVE FL 1",
            "city": "CRANSTON",
            "state": "RI",
            "postal_code": "029207023",
            "telephone_number": "401-209-7094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1090 CRANSTON ST",
            "city": "CRANSTON",
            "state": "RI",
            "postal_code": "029207323",
            "telephone_number": "401-781-3990",
            "fax_number": "401-223-0121"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "49 Westfield St Ste 14",
            "address_purpose": "LOCATION",
            "city": "Providence",
            "state": "RI",
            "postal_code": "029072593",
            "country_code": "US",
            "telephone_number": "401-209-7094",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VIDAL",
        "first_name": "JOSEFA",
        "middle_name": "NICOLE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-09",
        "last_updated": "2025-12-22",
        "certification_date": "2025-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "RI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "NextGen",
            "affiliation": "N",
            "address_1": "1090 Cranston St",
            "city": "Cranston",
            "state": "RI",
            "country_code": "US",
            "postal_code": "029207323",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Cranston, RI

Sources for this page

Verify at the official NPI Registry.