Healthcare Provider Details

I. General information

NPI: 1619498664
Provider Name (Legal Business Name): SHAUNA MCCAFFERTY LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 N MAIN ST UNIT 4
PROVIDENCE RI
02904-5770
US

IV. Provider business mailing address

152 HOLLAND AVE
RIVERSIDE RI
02915-2049
US

V. Phone/Fax

Practice location:
  • Phone: 401-276-4020
  • Fax:
Mailing address:
  • Phone: 401-516-4603
  • Fax: 401-696-8389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCSW02075
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberISW03117
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: