Healthcare Provider Details

I. General information

NPI: 1760422018
Provider Name (Legal Business Name): ELEANOR T HOWARD LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 03/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 CLOCK TOWER SQ
PORTSMOUTH RI
02871-1396
US

IV. Provider business mailing address

243 WAPPING RD
PORTSMOUTH RI
02871
US

V. Phone/Fax

Practice location:
  • Phone: 401-835-3694
  • Fax:
Mailing address:
  • Phone: 401-846-5787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW01365
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: