Provider Demographics
NPI:1073648721
Name:ELHARD, EDWIN (LICSW)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:ELHARD
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 COLLEGE HILL RD
Mailing Address - Street 2:29C
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2776
Mailing Address - Country:US
Mailing Address - Phone:401-822-4673
Mailing Address - Fax:401-822-4676
Practice Address - Street 1:33 COLLEGE HILL
Practice Address - Street 2:29C
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2776
Practice Address - Country:US
Practice Address - Phone:401-822-4673
Practice Address - Fax:401-822-4676
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1124101YA0400X
MT7971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical