MEDICARE: MRS. SHARON T RUST LICWS

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 01229	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	340648	OTHER	RI	TRI-CARE
2	1021100	OTHER	NE	NHP - GROUP NUMBER
3	406910	OTHER	RI	BLUE CHIP
4	30641-2	OTHER	RI	BLUE CROSS/ BLUE SHIELD
5	311822	OTHER	RI	MAGELLAN- GROUP NUMBER
6	62-27979	OTHER	RI	UNITED BEHAVIORAL HEALTH
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801907571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHARON T RUST LICWS

Provider Business Mailing Address
First Line	:	87 BISMARK AVE
Second Line	:
City	:	TIVERTON
State	:	RI
Zip	:	02878-2034
Country	:	US
Telephone Number	:	401-207-4316
Fax Number	:	401-375-5224

Provider Business Practice Location Address
First Line	:	8 NECK RD
Second Line	:
City	:	TIVERTON
State	:	RI
Zip	:	02878-4010
Country	:	US
Telephone Number	:	401-207-4316
Fax Number	:	401-207-4316

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	10/02/2023

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