Provider Demographics
NPI:1225081698
Name:ROUSLIN, MARCIA LOIS (LICSW)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:LOIS
Last Name:ROUSLIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 HERITAGE RD
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-2710
Mailing Address - Country:US
Mailing Address - Phone:401-245-1042
Mailing Address - Fax:401-245-1431
Practice Address - Street 1:654 METACOM AVE
Practice Address - Street 2:SUITE #6
Practice Address - City:WARREN
Practice Address - State:RI
Practice Address - Zip Code:02885-2300
Practice Address - Country:US
Practice Address - Phone:401-245-0375
Practice Address - Fax:401-245-0375
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW 001891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI3778-9OtherBLUE CROSS BLUE SHIELD