MEDICARE: MARCIA LOIS ROUSLIN LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	ISW 00189	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3778-9	OTHER	RI	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1225081698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCIA LOIS ROUSLIN LICSW

Provider Business Mailing Address
First Line	:	5 HERITAGE RD
Second Line	:
City	:	BARRINGTON
State	:	RI
Zip	:	02806-2710
Country	:	US
Telephone Number	:	401-245-1042
Fax Number	:	401-245-1431

Provider Business Practice Location Address
First Line	:	654 METACOM AVE
Second Line	:	SUITE #6
City	:	WARREN
State	:	RI
Zip	:	02885-2300
Country	:	US
Telephone Number	:	401-245-0375
Fax Number	:	401-245-0375

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	07/09/2007

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