Provider Demographics
NPI:1003320581
Name:MYER, EMILY (LICSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:MYER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 ALLENS AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-5010
Mailing Address - Country:US
Mailing Address - Phone:401-780-2511
Mailing Address - Fax:401-780-2565
Practice Address - Street 1:434 MOUNT PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-3302
Practice Address - Country:US
Practice Address - Phone:888-612-7242
Practice Address - Fax:401-444-0421
Is Sole Proprietor?:No
Enumeration Date:2017-11-20
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2223011041C0700X
VT097.01252661041C0700X
RIISW033561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1851444616OtherPRIVATE INSURANCE
MA042174657Medicaid