Individual provider Active NPI

Diane Elaine Reese, LCSW

  • Clinical Social Worker
  • Charlestown, RI
National Provider Identifier
1609899855
Registry record updated Mar 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
ISW03116 Issued in RI
Practice address
4705 Old Post Rd Unit a
Charlestown, RI 02813-1842
Phone
(401) 364-7705
NPI assigned
Jul 26, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X CT
Clinical Social Worker 1041C0700X ISW03116 RI Primary

Addresses

Primary practice location

4705 Old Post Rd Unit a
Charlestown, RI 02813-1842

Mailing address

117 Ellenfiled Street
Suite 101
Providence, RI 02905-4513
Phone (401) 364-7705

Other practice location 1

675 Tower Avenue
Suite 301
Hartford, CT 06112
Phone (860) 714-2750

Other identifiers 1

IdentifierTypeStateIssuer
004235091MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT, RI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20090915000616 CT Practitioner - Clinical Social Worker 4385790435 Reassigns benefits to 1 organization
I20210413000878 RI Practitioner - Clinical Social Worker 4385790435 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Gateway Healthcare IncGroup PAC ID 7719874908, 66 clinicians

Practice addresses (Care Compare)

4705 Old Post Rd
Unit a
Charlestown, RI 02813-1842
Phone (401) 364-7705

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ISW03116RIMDClinical Social Worker
004607CTMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Gateway Healthcare Inc CurrentSince Jan 12, 2021 Accepting new patients
Saint Francis Hospital and Medical Center CurrentSince Aug 3, 2009 Accepting new patients
South Shore Center Inc Clinical CurrentSince Jan 12, 2021 Accepting new patients
Saint Francis Hospital and Medical Center CurrentSince Aug 3, 2009 Accepting new patients

Locations

114 Woodland St
Hartford, CT 06105
Phone (860) 714-4001

500 Blue Hills Ave
Hartford, CT 06112
Phone (860) 714-2681

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

1443 Hartford Ave
Providence, RI 02919
Phone (401) 273-8100

117 Ellenfield St
Ste 101
Providence, RI 02905
Phone (401) 444-4318

1 Virginia Ave
Ste 200
Providence, RI 02905

Organizations & group practices 4

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": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614729600000",
    "number": "1609899855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 ELLENFILED STREET",
            "address_2": "SUITE 101",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029054513",
            "telephone_number": "401-364-7705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4705 OLD POST RD UNIT A",
            "city": "CHARLESTOWN",
            "state": "RI",
            "postal_code": "028131842",
            "telephone_number": "401-364-7705"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "675 Tower Avenue",
            "address_2": "Suite 301",
            "address_purpose": "LOCATION",
            "city": "Hartford",
            "state": "CT",
            "postal_code": "06112",
            "country_code": "US",
            "telephone_number": "860-714-2750",
            "fax_number": "860-714-8591",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REESE",
        "first_name": "DIANE",
        "middle_name": "ELAINE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-26",
        "last_updated": "2021-03-03",
        "certification_date": "2021-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "RI",
            "license": "ISW03116",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004235091",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlestown, RI

Sources for this page

Verify at the official NPI Registry.