Provider Demographics
NPI:1023164985
Name:RICHMAN, KELLY M (LICSW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:M
Last Name:RICHMAN
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 1:10 EAST ST
Mailing Address - Street 2:UNIT 115
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-4469
Mailing Address - Country:US
Mailing Address - Phone:401-578-8495
Mailing Address - Fax:401-921-5493
Practice Address - Street 1:17 ASHTON PKWY
Practice Address - Street 2:SUITE 201
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-4827
Practice Address - Country:US
Practice Address - Phone:401-578-8495
Practice Address - Fax:401-921-5493
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW010321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical