=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275713679
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIN HUNT ESTRELLA LICSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2007
-----------------------------------------------------
Last Update Date | 10/04/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 394 ANGELL ST FL 1
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02906-4005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-440-1277
-----------------------------------------------------
Fax | 401-223-6301
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1713
-----------------------------------------------------
City | WEST TISBURY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02575-1713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-440-1277
-----------------------------------------------------
Fax | 401-223-6301
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | CSW01117
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 214820
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | ISW02075
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------