Provider Demographics
NPI:1316050776
Name:KALAIDJIAN, DAPHNE LYDIA (LICSW)
Entity type:Individual
Prefix:
First Name:DAPHNE
Middle Name:LYDIA
Last Name:KALAIDJIAN
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 1:19 FRIENDSHIP ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-2200
Mailing Address - Country:US
Mailing Address - Phone:401-578-4453
Mailing Address - Fax:
Practice Address - Street 1:19 FRIENDSHIP ST
Practice Address - Street 2:SUITE 240
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-2200
Practice Address - Country:US
Practice Address - Phone:401-578-4453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW00712101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health