Provider Demographics
NPI:1528149853
Name:HEISS, ELIZABETH G (PHD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:G
Last Name:HEISS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1464 DIAMOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-5540
Mailing Address - Country:US
Mailing Address - Phone:401-333-3810
Mailing Address - Fax:401-333-1675
Practice Address - Street 1:1464 DIAMOND HILL RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-5540
Practice Address - Country:US
Practice Address - Phone:401-333-3810
Practice Address - Fax:401-333-1675
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00416103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7005979Medicare ID - Type Unspecified