=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538458328
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SKILLS IN MOTION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2011
-----------------------------------------------------
Last Update Date | 10/09/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 166 LAVAN ST
-----------------------------------------------------
City | WARWICK
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02888-1059
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-787-1178
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 104 MASSASOIT AVE
-----------------------------------------------------
City | BARRINGTON
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02806-3129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-787-1178
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL SOCIAL WORKER
-----------------------------------------------------
Name | MS. LORNA C SWEARINGEN
-----------------------------------------------------
Credential | LICSW
-----------------------------------------------------
Telephone | 401-787-1178
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | ISW00006
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------