Provider Demographics
NPI:1134955081
Name:GOETZ, EMERSYN
Entity type:Individual
Prefix:
First Name:EMERSYN
Middle Name:
Last Name:GOETZ
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 HOPE ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-2001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:132 OLD RIVER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-1158
Practice Address - Country:US
Practice Address - Phone:781-327-0827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW038241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical