Basic Information
| Provider Information | |||||||||
| NPI: | 1720020522 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOONEY | ||||||||
| FirstName: | SHEILA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 ORMS ST | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029042228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014530666 | ||||||||
| FaxNumber: | 4014539619 | ||||||||
| Practice Location | |||||||||
| Address1: | 1534 ATWOOD AVE | ||||||||
| Address2: | SUITE 213 | ||||||||
| City: | JOHNSTON | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029193223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013510400 | ||||||||
| FaxNumber: | 4013510410 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | ISW01005 | RI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 407729 | 01 | RI | BLUE CHIP PROVIDER # | OTHER | 30859-1 | 01 | RI | BLUE SHIELD PROVIDER # | OTHER | 81209 | 01 | RI | UNITED HEALTH PROVIDER # | OTHER |