Healthcare Provider Details

I. General information

NPI: 1497769467
Provider Name (Legal Business Name): LIZBETH ERNA WOLFGANG PHD PSYCHOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 SALT POND ROAD SUITE D4
WAKEFIELD RI
02879
US

IV. Provider business mailing address

555 TILLINGHAST ROAD
EAST GREENWICH RI
02818
US

V. Phone/Fax

Practice location:
  • Phone: 401-789-3694
  • Fax: 401-789-3748
Mailing address:
  • Phone: 401-885-5891
  • Fax: 401-789-3748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number814
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: