Individual
SAMUEL WALLACE PELOQUIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
400 MASSASOIT AVE STE 305, EAST PROVIDENCE, RI 02914-2012
(401) 499-1043
Mailing address
400 MASSASOIT AVE STE 305, EAST PROVIDENCE, RI 02914-2012
(401) 499-1043
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
ISW03231
RI
1041C0700X
Clinical Social Worker
Primary
ISW023231
RI
Other
Enumeration date
05/22/2022
Last updated
04/30/2026
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