Provider Demographics
NPI:1134148950
Name:LANDRY, EILEEN P (LICSW)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:P
Last Name:LANDRY
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 1:68 CUMBERLAND ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-3323
Mailing Address - Country:US
Mailing Address - Phone:401-356-1940
Mailing Address - Fax:401-356-1949
Practice Address - Street 1:68 CUMBERLAND ST
Practice Address - Street 2:SUITE 102
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-3323
Practice Address - Country:US
Practice Address - Phone:401-356-1940
Practice Address - Fax:401-356-1949
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW008371041C0700X
MA1077381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI413301OtherBLUE CHIP
RI495432OtherTUFTS
RI314118OtherBLUE CROSS BLUE SHIELD
RI6221833OtherUNITED HEALTH CARE
RIEL04089Medicaid