Provider Demographics
NPI:1396152898
Name:WALEN, ELAINE K (MS, MA, PSYD)
Entity type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:K
Last Name:WALEN
Suffix:
Gender:F
Credentials:MS, MA, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 SCRABBLETOWN RD STE A
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-3638
Mailing Address - Country:US
Mailing Address - Phone:401-268-5333
Mailing Address - Fax:
Practice Address - Street 1:1170 PONTIAC AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-7944
Practice Address - Country:US
Practice Address - Phone:401-500-0424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS02033103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist