=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164895876
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ARIANA MACHADO MSW, QMHP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2015
-----------------------------------------------------
Last Update Date | 05/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11 FRIENDSHIP ST
-----------------------------------------------------
City | NEWPORT
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02840-2299
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-846-6400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1443 HARTFORD AVE
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02919-3224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-785-2666
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | CSW03625
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------