Provider Demographics
NPI:1013361492
Name:ROPER, MAIA R (MSW, LICSW)
Entity Type:Individual
Prefix:MRS
First Name:MAIA
Middle Name:R
Last Name:ROPER
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 OLD LOUISQUISSET PIKE STE 105
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-4503
Mailing Address - Country:US
Mailing Address - Phone:857-293-5020
Mailing Address - Fax:857-226-8772
Practice Address - Street 1:1525 OLD LOUISQUISSET PIKE STE 105
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-4503
Practice Address - Country:US
Practice Address - Phone:857-293-5020
Practice Address - Fax:857-226-8772
Is Sole Proprietor?:No
Enumeration Date:2016-04-21
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW022981041C0700X
MA2251521041C0700X
MA001243661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical