Provider Demographics
NPI:1215048160
Name:FARIA, KELLEY MARIE (LMHC)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:MARIE
Last Name:FARIA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-4509
Mailing Address - Country:US
Mailing Address - Phone:401-383-0437
Mailing Address - Fax:
Practice Address - Street 1:2699 POST RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-3075
Practice Address - Country:US
Practice Address - Phone:401-924-5013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00298101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI413827OtherBLUE CHIP
RI31793-1OtherBLUE CROSS BLUE SHIELD