Provider Demographics
NPI:1811902562
Name:TRIPP, EMILY C (LICSW)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:C
Last Name:TRIPP
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 1:35 HIAWATHA DR
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:RI
Mailing Address - Zip Code:02822-3610
Mailing Address - Country:US
Mailing Address - Phone:401-405-9303
Mailing Address - Fax:
Practice Address - Street 1:55 HOPE ST
Practice Address - Street 2:C/O FAMILY SERVICE OF RHODE ISLAND
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2001
Practice Address - Country:US
Practice Address - Phone:401-331-1350
Practice Address - Fax:401-277-3366
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW008391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1021740OtherNHP/BEACON GROUP NUMBER
RIET60086Medicaid