Basic Information
| Provider Information | |||||||||
| NPI: | 1003320581 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MYER | ||||||||
| FirstName: | EMILY | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 375 ALLENS AVE | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029055010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017802511 | ||||||||
| FaxNumber: | 4017802565 | ||||||||
| Practice Location | |||||||||
| Address1: | 434 MOUNT PLEASANT AVE | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029083302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8886127242 | ||||||||
| FaxNumber: | 4014440421 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2017 | ||||||||
| LastUpdateDate: | 10/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 222301 | MA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 097.0125266 | VT | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | ISW03356 | RI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 1851444616 | 01 | MA | PRIVATE INSURANCE | OTHER | 042174657 | 05 | MA | MEDICAID |