MEDICARE: ELIZABETH WELSHMAN LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	ISW01767	RI

General Provider Information

NPI Number	:	1770726036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH WELSHMAN LICSW

Provider Business Mailing Address
First Line	:	1130 TEN ROD RD STE C207
Second Line	:
City	:	NORTH KINGSTOWN
State	:	RI
Zip	:	02852-4127
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1130 TEN ROD RD STE C207
Second Line	:
City	:	NORTH KINGSTOWN
State	:	RI
Zip	:	02852-4127
Country	:	US
Telephone Number	:	401-294-8181
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2009
Last Update Date	:	04/20/2009

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