Provider Demographics
NPI:1104919117
Name:RIVELLI, KELLI (LICSW)
Entity type:Individual
Prefix:MISS
First Name:KELLI
Middle Name:
Last Name:RIVELLI
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 1:1126 HARTFORD AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-7130
Mailing Address - Country:US
Mailing Address - Phone:401-351-2750
Mailing Address - Fax:401-351-7002
Practice Address - Street 1:1126 HARTFORD AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-7130
Practice Address - Country:US
Practice Address - Phone:401-351-2750
Practice Address - Fax:401-351-7002
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIL.C.D.P. # NOT RCVD101Y00000X
RIISW042591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RITT24187Medicaid