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NPI Code Detail

MEDICARE: STEVE BERUBE LICSW

MEDICARE: STEVE BERUBE 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
11041C0700XClinical Social WorkerISW01562RI
21041C0700XClinical Social WorkerMA LR 110751MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1411408OTHERRIBLUE CHIP
262-84727OTHERRIUBH
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
427094-2OTHERRIBLUE CROSS

General Provider Information

NPI Number : 1720068521
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEVE BERUBE LICSW
Provider Business Mailing Address
First Line : 140 ROCKY HILL RD
Second Line :
City : REHOBOTH
State : MA
Zip : 02769-1413
Country : US
Telephone Number : 508-212-5334
Fax Number :
Provider Business Practice Location Address
First Line : 610 WAMPANOAG TRL
Second Line :
City : EAST PROVIDENCE
State : RI
Zip : 02915-1504
Country : US
Telephone Number : 401-431-9870
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2006
Last Update Date : 07/08/2007

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Directions to “ STEVE BERUBE LICSW” Practice Location

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