Active NPI
Robert B Marshall, LICSW
- Clinical Social Worker
- Pawtucket, RI
National Provider Identifier
1912965526
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Practice address
- 103 Bacon St
Pawtucket, RI 02860-5542 - Phone
- (401) 728-3750
- NPI assigned
- May 3, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 1SW00225 | RI | |
| Clinical Social Worker | 1041C0700X | Primary |
Addresses
Primary practice location
103 Bacon St
Pawtucket, RI 02860-5542
Mailing address
249 Roosevelt Avenue
Suite 205 Gatway Healthcare Inc
Pawtucket, RI 02860
Phone (401) 724-8400
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RM20115 | Medicaid | RI | |
| 407698 | Other | RI | B CHIP |
| 30589 | Other | RI | BC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1SW00225 | RI | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146614400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1362960000000",
"number": "1912965526",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "249 ROOSEVELT AVENUE",
"address_2": "SUITE 205 GATWAY HEALTHCARE INC",
"city": "PAWTUCKET",
"state": "RI",
"postal_code": "02860",
"telephone_number": "401-724-8400",
"fax_number": "401-365-1100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "103 BACON ST",
"city": "PAWTUCKET",
"state": "RI",
"postal_code": "028605542",
"telephone_number": "401-728-3750"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARSHALL",
"first_name": "ROBERT",
"middle_name": "B",
"name_prefix": "Mr.",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-03",
"last_updated": "2013-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "RI",
"license": "1SW00225",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "RM20115",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "B CHIP",
"identifier": "407698",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC",
"identifier": "30589",
"state": "RI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pawtucket, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.