Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Samuel Wallace Peloquin, LICSW

Individual provider Social Worker · NPI 1154069045

Samuel Wallace Peloquin, LICSW is a Clinical Social Worker in East Providence, Rhode Island. Qualified in 2017, 9 years ago. Licensed in Rhode Island.

Years since qualifying
9
Licensed in
RI
In the registry since
2022
Specialties on file
2
What do these letters mean?
LICSW — Licensed Independent Clinical Social Worker
The title some states use for an independently practising clinical social worker.

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Practice location Address checks out

400 Massasoit Ave Ste 305
East Providence, RI 02914-2012
Phone: (401) 499-1043
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence ISW023231 (RI)
Social Worker Taxonomy 104100000X · Licence ISW03231 (RI)

Record details

NPI number1154069045
Entity typeIndividual (Type 1)
GenderMale
Credentials LICSW
Sole proprietorNo
NPI enumeratedMay 22, 2022
Last updated in NPPESApril 30, 2026
Certification dateApril 30, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Accepts Medicare assignment Not indicated
Practice locations4 on file with Medicare

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