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General NPI Number Information
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NPI Number | 1912665001
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Entity Type | Individual
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Provider Name | EMILY SUSAN RUPERT LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/06/2021
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 20 COMMONS CORNER WAY SOUTH COUNTY COMMONS BLDG 12
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City | WAKEFIELD
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State | RI
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Zip | 02879
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Country | US
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Telephone | 401-294-6170
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Fax | 401-295-5255
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Provider Business Mailing Address
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Address Line | 455 TOLL GATE RD
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City | WARWICK
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State | RI
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Zip | 02886-2759
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Country | US
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Telephone | 401-273-0641
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Fax | 401-273-2919
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ISW04179
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License Number State | RI
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