Individual provider Active NPI

Pamela L Riley, LICSW

  • Clinical Social Worker
  • Providence, RI
National Provider Identifier
1922362011
Registry record updated Jul 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
ISW02162 Issued in RI
Practice address
100 Butler Dr
Providence, RI 02906-4862
Phone
(401) 227-3669
Fax
(401) 736-1010
NPI assigned
Jul 3, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 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 ISW02162 RI Primary

Addresses

Primary practice location

100 Butler Dr
Providence, RI 02906-4862

Mailing address

455 Toll Gate Road
PRC and Credentialing
Warwick, RI 02886-2759
Phone (401) 243-0641

Other practice location 1

345 Blackstone Blvd
Providence, RI 02906-4800
Phone (401) 455-6200

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
I20220524000260 RI Practitioner - Clinical Social Worker 6800273301 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
Group practices
Affinity Physicians LLC.Group PAC ID 0244413391, 723 clinicians

Practice addresses (Care Compare)

455 Toll Gate Rd
Warwick, RI 02886-2759
Phone (401) 737-7010

455 Tollgate Rd
Warwick, RI 02886-2759

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ISW02162RIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Affinity Physicians LLC. CurrentSince Oct 31, 2025 Accepting new patients
Affinity Physicians LLC CurrentSince Oct 31, 2025 Accepting new patients
Lifespan Physician Group, Inc. Clinical PastSince May 1, 2022 Accepting new patients

Locations

593 Eddy St
#3
Providence, RI 02903
Phone (401) 444-3534

100 Butler Dr
Providence, RI 02906
Phone (401) 277-0790

345 Blackstone Blvd
Providence, RI 02906
Phone (401) 455-6375

455 Toll Gate Rd
Warwick, RI 02886
Phone (401) 737-7000

Organizations & group practices 3

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": "1341273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751932800000",
    "number": "1922362011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 TOLL GATE ROAD",
            "address_2": "PRC AND CREDENTIALING",
            "city": "WARWICK",
            "state": "RI",
            "postal_code": "028862759",
            "telephone_number": "401-243-0641",
            "fax_number": "401-273-2919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 BUTLER DR",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029064862",
            "telephone_number": "401-227-3669",
            "fax_number": "401-736-1010"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "345 Blackstone Blvd",
            "address_purpose": "LOCATION",
            "city": "Providence",
            "state": "RI",
            "postal_code": "029064800",
            "country_code": "US",
            "telephone_number": "401-455-6200",
            "fax_number": "401-455-6689",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RILEY",
        "first_name": "PAMELA",
        "middle_name": "L",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-03",
        "last_updated": "2025-07-08",
        "certification_date": "2025-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "RI",
            "license": "ISW02162",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.