Provider Demographics
NPI:1366532160
Name:NEVILLE, CATHERINE C I (LICSW)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:C
Last Name:NEVILLE
Suffix:I
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 1:58 EUSTIS AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-2338
Mailing Address - Country:US
Mailing Address - Phone:919-414-7042
Mailing Address - Fax:
Practice Address - Street 1:58 EUSTIS AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840
Practice Address - Country:US
Practice Address - Phone:919-414-7042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW027891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106140Medicaid
NC6003751Medicaid
NC2871927Medicare ID - Type Unspecified