Jane Mary Willis, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

ISW00353 Issued in RI

Practice address

100 Lafayette St
Suite 305
Pawtucket, RI 02860-6008

Phone

(401) 722-9091

Fax

(401) 722-5451

NPI assigned

Dec 2, 2006

Sex

Female

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Apr 17, 2016 through Apr 17, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Bridges Counseling Center, LLC

  • Clinical Social Worker
  • Pawtucket, RI
  • NPI 1467520734
  NPD (past) Authorized official

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

{
    "created_epoch": "1165017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1568530830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 LAFAYETTE ST",
            "address_2": "SUITE 305",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028606008",
            "telephone_number": "401-722-9091",
            "fax_number": "401-722-5451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 LAFAYETTE ST",
            "address_2": "SUITE 305",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028606008",
            "telephone_number": "401-722-9091",
            "fax_number": "401-722-5451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "JANE",
        "middle_name": "MARY",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "RI",
            "license": "ISW00353",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Wiley, DO
• Carrie Williams, MASTERS
• Christine Lucene Williams, LICSW
• Edward Williams, MASTERS
• Robert Williams, MD
• Willow Street Medical Laboratory LLC
• Julie M Wilson, PH.D.
• Kar Wilson Jr.
• Janet Ann Wing, MSW
• Wise Self, LLC

• Clinical Social Worker in Pawtucket, RI
• Providers in Pawtucket, 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 Jul 8, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.