Healthcare Provider Details

I. General information

NPI: 1801907571
Provider Name (Legal Business Name): SHARON T RUST LICWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 NECK RD
TIVERTON RI
02878-4010
US

IV. Provider business mailing address

87 BISMARK AVE
TIVERTON RI
02878-2034
US

V. Phone/Fax

Practice location:
  • Phone: 401-207-4316
  • Fax: 401-207-4316
Mailing address:
  • Phone: 401-207-4316
  • Fax: 401-375-5224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW 01229
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: