Provider Demographics
NPI:1598876211
Name:HYMAN, ELIZABETH M (LICSW)
Entity Type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:M
Last Name:HYMAN
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 1:25 PARKER AVE
Mailing Address - Street 2:APT 7
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-6940
Mailing Address - Country:US
Mailing Address - Phone:401-847-0352
Mailing Address - Fax:
Practice Address - Street 1:15 HIGH ST
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-1853
Practice Address - Country:US
Practice Address - Phone:401-841-8896
Practice Address - Fax:401-848-4192
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW004601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI406578OtherBLUE CHIP
RI1021100OtherNHP - GROUP NUMBER
RI62-58145OtherUNITED BEHAVIORAL HEALTH
RI311822OtherMAGELLAN- GROUP NUMBER
RI7439-1OtherBLUE CROSS/ BLUE SHIELD
RI351318OtherTRI-CARE
RIEH06879Medicaid
RI007057268Medicare ID - Type Unspecified