Provider Demographics
NPI:1396428728
Name:FORTIN, ELIZABETH (MSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:FORTIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 TOWER HILL RD
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-5627
Mailing Address - Country:US
Mailing Address - Phone:401-215-5503
Mailing Address - Fax:401-788-8529
Practice Address - Street 1:1 HIGH ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-3103
Practice Address - Country:US
Practice Address - Phone:401-788-2310
Practice Address - Fax:401-788-8529
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW002621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical