Provider Demographics
NPI:1497769467
Name:WOLFGANG, LIZBETH ERNA (PHD PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:LIZBETH
Middle Name:ERNA
Last Name:WOLFGANG
Suffix:
Gender:F
Credentials:PHD PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:555 TILLINGHAST ROAD
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818
Mailing Address - Country:US
Mailing Address - Phone:401-885-5891
Mailing Address - Fax:401-789-3748
Practice Address - Street 1:24 SALT POND ROAD
Practice Address - Street 2:SUITE D4
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879
Practice Address - Country:US
Practice Address - Phone:401-789-3694
Practice Address - Fax:401-789-3748
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI814103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI306681OtherBLUE CROSS
RILW49844Medicaid
RI410947OtherBLUE CHIP