Basic Information
Provider Information | |||||||||
NPI: | 1144236852 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KELLY-PALMER | ||||||||
FirstName: | SARAH | ||||||||
MiddleName: | A | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | LICSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 7 SILBY ST | ||||||||
Address2: |   | ||||||||
City: | WARWICK | ||||||||
State: | RI | ||||||||
PostalCode: | 028891134 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4013311350 | ||||||||
FaxNumber: | 4012773366 | ||||||||
Practice Location | |||||||||
Address1: | 55 HOPE ST | ||||||||
Address2: | C/O FAMILY SERVICE OF RHODE ISLAND | ||||||||
City: | PROVIDENCE | ||||||||
State: | RI | ||||||||
PostalCode: | 029062001 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4013311350 | ||||||||
FaxNumber: | 4012773366 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/01/2006 | ||||||||
LastUpdateDate: | 12/26/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | ISW01849 | RI | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
ID | Type | State | Issuer | Description | 33042-8 | 01 |   | BLUE CROSS BLUE SHIELD RI | OTHER | 1021740 | 01 |   | NHP/BEACON GROUP NUMBER | OTHER | 600250-584 | 01 |   | MAGELLAN | OTHER | 007059640 | 01 |   | MEDICARE | OTHER | SK57549 | 05 | RI |   | MEDICAID | 414314 | 01 |   | BLUE CHIP | OTHER |