=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598876211
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH M HYMAN LICSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 12/16/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15 HIGH ST
-----------------------------------------------------
City | WESTERLY
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02891-1853
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-841-8896
-----------------------------------------------------
Fax | 401-848-4192
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25 PARKER AVE APT 7
-----------------------------------------------------
City | NEWPORT
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02840-6940
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-847-0352
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | ISW00460
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------