Provider Demographics
NPI:1730252743
Name:GRIJALVA, KATHERINE (MA EDUCATION GRADUAT)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:
Last Name:GRIJALVA
Suffix:
Gender:F
Credentials:MA EDUCATION GRADUAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BEAVER RD
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-1602
Mailing Address - Country:US
Mailing Address - Phone:401-246-0085
Mailing Address - Fax:
Practice Address - Street 1:610 WAMPANOAG TRAIL
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02915-1506
Practice Address - Country:US
Practice Address - Phone:401-431-9870
Practice Address - Fax:401-438-1957
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMFT00130106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist