Healthcare Provider Details

I. General information

NPI: 1871801563
Provider Name (Legal Business Name): ELIZABETH MERRILL VACHON LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 09/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1639 POST RD
WARWICK RI
02888-5959
US

IV. Provider business mailing address

1639 POST RD
WARWICK RI
02888-5959
US

V. Phone/Fax

Practice location:
  • Phone: 401-952-9341
  • Fax: 401-732-6479
Mailing address:
  • Phone: 401-952-9341
  • Fax: 401-732-6479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW01203
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: