Individual
ELAINE LOUISE MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
1 RICHMOND SQ STE 232E, PROVIDENCE, RI 02906-5139
(401) 354-9372
(401) 633-6739
Mailing address
1 RICHMOND SQ STE 232E, PROVIDENCE, RI 02906-5139
(401) 354-9372
(401) 633-6739
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
ISW00638
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
411931
PSYCHOTHERAPIST
RI
01
—
62-27220
PSYCHOTHERAPIST
RI
01
—
7183-1
PSYCHOTHERAPIST
RI
01
—
8090036381
MEDICARE PTAN
RI
Enumeration date
08/04/2006
Last updated
01/23/2020
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