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Individual

ELIZABETH BOGARDUS ISON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LICSW SOCIAL WORKER

Contact information

Practice address
24 SALT POND ROAD, STE D4, WAKEFIELD, RI 02879
(401) 789-3694
(401) 789-3748
Mailing address
165 NORTH ROAD, SOUTH KINGSTOWN, RI 02879
(401) 782-2896
(401) 789-3748

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
ISW01309
RI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
263186
RI BLUE CROSS
RI
05
EI41628
RI
Enumeration date
08/02/2006
Last updated
07/08/2007
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