Provider Demographics
NPI:1669594818
Name:EMERSON, ELISSA (PHD, PMHCNS, ARNP,)
Entity type:Individual
Prefix:DR
First Name:ELISSA
Middle Name:
Last Name:EMERSON
Suffix:
Gender:F
Credentials:PHD, PMHCNS, ARNP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 CUMMINGS WAY
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-0856
Mailing Address - Country:US
Mailing Address - Phone:401-235-7000
Mailing Address - Fax:401-767-9177
Practice Address - Street 1:55 CUMMINGS WAY
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-0856
Practice Address - Country:US
Practice Address - Phone:401-235-7000
Practice Address - Fax:401-767-9177
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9233417363LF0000X, 364SP0808X
RIPPNS00102364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIEE86700Medicaid
FLQ20801Medicare UPIN