Provider Demographics
NPI:1710095484
Name:PACKHEM, ELIZABETH A (RN LCDCS CD)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:A
Last Name:PACKHEM
Suffix:
Gender:F
Credentials:RN LCDCS CD
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:A
Other - Last Name:MCHALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:166 VINEYARD RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02889
Mailing Address - Country:US
Mailing Address - Phone:401-737-7941
Mailing Address - Fax:
Practice Address - Street 1:70 MINNESOTA AVE
Practice Address - Street 2:THE KENT CENTER
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888
Practice Address - Country:US
Practice Address - Phone:401-738-0685
Practice Address - Fax:401-738-4413
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILCDCS 00014101YA0400X
RIRN08467163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered163W00000XNursing Service ProvidersRegistered Nurse