Provider Demographics
NPI:1528010584
Name:THURBER, EARLE E (LICSW)
Entity Type:Individual
Prefix:
First Name:EARLE
Middle Name:E
Last Name:THURBER
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 1:249 ROOSEVELT AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PAWTUCKET
Mailing Address - State:WI
Mailing Address - Zip Code:02867
Mailing Address - Country:US
Mailing Address - Phone:401-724-8400
Mailing Address - Fax:401-365-1100
Practice Address - Street 1:351 EAST AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860
Practice Address - Country:US
Practice Address - Phone:401-725-4412
Practice Address - Fax:401-728-5310
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW01262104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIET23917Medicaid