MEDICARE: MRS. LINDA CAROLINE BRAULT LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	214419	MA
2	1041C0700X	Clinical Social Worker	ISW02269	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ISW02269	OTHER	RI	LICENSED INDEPENSANT CLINICAL SOCIAL WORKER

General Provider Information

NPI Number	:	1053565531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LINDA CAROLINE BRAULT LICSW

Provider Business Mailing Address
First Line	:	200 MAIN ST
Second Line	:
City	:	PAWTUCKET
State	:	RI
Zip	:	02860-4131
Country	:	US
Telephone Number	:	401-728-1800
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 MAIN ST
Second Line	:
City	:	PAWTUCKET
State	:	RI
Zip	:	02860-4131
Country	:	US
Telephone Number	:	401-728-1800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2008
Last Update Date	:	07/13/2021

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