Provider Demographics
NPI:1558306951
Name:FEISTHAMEL, ELIZABETH (LICSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:FEISTHAMEL
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 1:1351 SOUTH COUNTY TRAIL
Mailing Address - Street 2:STE 210 BLDG 2
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-5080
Mailing Address - Country:US
Mailing Address - Phone:401-884-2008
Mailing Address - Fax:401-884-2075
Practice Address - Street 1:1351 SOUTH COUNTY TRAIL
Practice Address - Street 2:STE 210 BLDG 2
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-5080
Practice Address - Country:US
Practice Address - Phone:401-884-2008
Practice Address - Fax:401-884-2075
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW011711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI30021-4OtherBLUE CROSS & BLUE SHIELD