Provider Demographics
NPI:1598803629
Name:SHERIDAN, ROBERT CARLIN (MSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:CARLIN
Last Name:SHERIDAN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 ANGELL ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906
Mailing Address - Country:US
Mailing Address - Phone:401-861-6747
Mailing Address - Fax:
Practice Address - Street 1:501 ANGELL ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906
Practice Address - Country:US
Practice Address - Phone:401-861-6747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW002341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI6242195OtherUBH
RI37891OtherBLUE CROSS & BLUE SHIELD