Theodore William Blickwedel II, MSW, LICSW
Individual provider Active NPI Mental Health Counselor · Johnston, RI
NPI 1669957932 · NPPES record last updated Oct 2, 2018
Key facts
- NPI
- 1669957932
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- ISW02141 (RI)
- Practice address
- 1395 Atwood Ave Ste 201
Johnston, RI 02919-4931 - Phone
- (401) 383-7633
- Fax
- (877) 266-4503
- NPI assigned
- Oct 2, 2018
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ISW02141 | RI | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Paradigm Shift | Mental Health | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | ISW02141 | RI | Yes |
Addresses
Primary practice location
1395 Atwood Ave Ste 201
Johnston, RI 02919-4931
Mailing address
1395 Atwood Ave Ste 201
Johnston, RI 02919-4931
Phone (401) 383-7633
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All providers in Johnston, RI · Mental Health Counselor in Rhode Island
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 2, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.