Healthcare Provider Details

I. General information

NPI: 1912416090
Provider Name (Legal Business Name): ELIZABETH FAIRCHILD GREENBERG LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2017
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 NOBERT ST
WARREN RI
02885-2511
US

IV. Provider business mailing address

5 NOBERT ST
WARREN RI
02885-2511
US

V. Phone/Fax

Practice location:
  • Phone: 401-935-8450
  • Fax:
Mailing address:
  • Phone: 401-935-8450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW1292
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: