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NPI Code Detail

MEDICARE: SOCIAL SPARKS INC

MEDICARE: SOCIAL SPARKS INC
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
1101Y00000XCounselor
2363LP0808XPsychiatric/Mental Health Nurse Practitioner
3222Q00000XDevelopmental Therapist
41041C0700XClinical Social WorkerISW02133RI

General Provider Information

NPI Number : 1871960575
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOCIAL SPARKS INC
Provider Business Mailing Address
First Line : 1992 OLD LOUISQUISSET PIKE
Second Line :
City : LINCOLN
State : RI
Zip : 02865-4590
Country : US
Telephone Number : 401-475-0653
Fax Number : 401-475-0729
Provider Business Practice Location Address
First Line : 1992 OLD LOUISQUISSET PIKE
Second Line :
City : LINCOLN
State : RI
Zip : 02865-4590
Country : US
Telephone Number : 401-475-0653
Fax Number : 401-475-0729
Authorized Official
Title or Position : OWNER
Name : KRISTEN ANGELA SPENCER
Credential :
Telephone Number : 401-475-0653
Provider Enumeration Date : 08/28/2015
Last Update Date : 02/21/2026

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