Provider Demographics
NPI:1194070508
Name:PELOQUIN, CAROL (LICSW)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:PELOQUIN
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 1:1516 ATWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-3223
Mailing Address - Country:US
Mailing Address - Phone:401-553-1000
Mailing Address - Fax:401-553-1046
Practice Address - Street 1:1516 ATWOOD AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-3223
Practice Address - Country:US
Practice Address - Phone:401-553-1000
Practice Address - Fax:401-553-1046
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
MALICSW1255881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIGH57134Medicaid