Samuel Wallace Peloquin, LICSW
Social Worker, Clinical in East Providence, RI. Individual provider (NPI-1).
NPI number1154069045
StatusActive
Last updated in NPPESApr 30, 2026
Details
- NPI
- 1154069045
- Entity type
- Individual (NPI-1)
- Name
- Samuel Wallace Peloquin
- Credential
- LICSW
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- May 22, 2022
- Certification date
- Apr 30, 2026
- Last updated
- Apr 30, 2026
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - CLINICAL SOCIAL WORKER
- Can order and refer
- Part B Yes · DME Yes · Home health No · Power mobility No · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | ISW023231 | RI | Yes |
| 104100000X | Social Worker | ISW03231 | RI |
Practice location
400 Massasoit Ave Ste 305East Providence, RI 02914-2012
Phone 401-499-1043
Mailing address
400 Massasoit Ave Ste 305East Providence, RI 02914-2012
Phone 401-499-1043
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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