Basic Information
Provider Information | |||||||||
NPI: | 1598876211 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HYMAN | ||||||||
FirstName: | ELIZABETH | ||||||||
MiddleName: | M | ||||||||
NamePrefix: | MISS | ||||||||
NameSuffix: |   | ||||||||
Credential: | LICSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 25 PARKER AVE | ||||||||
Address2: | APT 7 | ||||||||
City: | NEWPORT | ||||||||
State: | RI | ||||||||
PostalCode: | 028406940 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4018470352 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 15 HIGH ST | ||||||||
Address2: |   | ||||||||
City: | WESTERLY | ||||||||
State: | RI | ||||||||
PostalCode: | 028911853 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4018418896 | ||||||||
FaxNumber: | 4018484192 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/31/2006 | ||||||||
LastUpdateDate: | 12/16/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | ISW00460 | RI | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
ID | Type | State | Issuer | Description | 406578 | 01 | RI | BLUE CHIP | OTHER | 1021100 | 01 | RI | NHP - GROUP NUMBER | OTHER | 62-58145 | 01 | RI | UNITED BEHAVIORAL HEALTH | OTHER | 311822 | 01 | RI | MAGELLAN- GROUP NUMBER | OTHER | 7439-1 | 01 | RI | BLUE CROSS/ BLUE SHIELD | OTHER | 351318 | 01 | RI | TRI-CARE | OTHER | EH06879 | 05 | RI |   | MEDICAID |