Provider Demographics
NPI:1801907571
Name:RUST, SHARON T (LICWS)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:T
Last Name:RUST
Suffix:
Gender:F
Credentials:LICWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 BISMARK AVE
Mailing Address - Street 2:
Mailing Address - City:TIVERTON
Mailing Address - State:RI
Mailing Address - Zip Code:02878-2034
Mailing Address - Country:US
Mailing Address - Phone:401-207-4316
Mailing Address - Fax:401-375-5224
Practice Address - Street 1:8 NECK RD
Practice Address - Street 2:
Practice Address - City:TIVERTON
Practice Address - State:RI
Practice Address - Zip Code:02878-4010
Practice Address - Country:US
Practice Address - Phone:401-207-4316
Practice Address - Fax:401-207-4316
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW 012291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI340648OtherTRI-CARE
NE1021100OtherNHP - GROUP NUMBER
RI406910OtherBLUE CHIP
RI30641-2OtherBLUE CROSS/ BLUE SHIELD
RI311822OtherMAGELLAN- GROUP NUMBER
RI62-27979OtherUNITED BEHAVIORAL HEALTH
RISR31997Medicaid
NE1021100OtherNHP - GROUP NUMBER