Basic Information
| Provider Information | |||||||||
| NPI: | 1023109915 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCAULEY | ||||||||
| FirstName: | SALLY | ||||||||
| MiddleName: | |||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 272 PONTIAC AVE # 2 | ||||||||
| Address2: | |||||||||
| City: | CRANSTON | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029102003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4019413144 | ||||||||
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| Practice Location | |||||||||
| Address1: | 55 JOHN A CUMMINGS WAY | ||||||||
| Address2: | |||||||||
| City: | WOONSOCKET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028953247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4012357000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 02/24/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | ISW01401 | RI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YA0400X | CDP00448 | RI | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | SM52074 | 05 | RI | MEDICAID | 0000030603 | 01 | RI | BLUE CROSS | OTHER | 6281078 | 01 | RI | UNITED HEALTH | OTHER | 409691 | 01 | RI | BLUE CHIP | OTHER |