Healthcare Provider Details

I. General information

NPI: 1023109915
Provider Name (Legal Business Name): SALLY MCAULEY LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 02/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 JOHN A CUMMINGS WAY
WOONSOCKET RI
02895-3247
US

IV. Provider business mailing address

272 PONTIAC AVE # 2
CRANSTON RI
02910-2003
US

V. Phone/Fax

Practice location:
  • Phone: 401-235-7000
  • Fax:
Mailing address:
  • Phone: 401-941-3144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDP00448
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW01401
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: