Provider Demographics
NPI:1316055197
Name:GYRA, KIMBERLY ANN (MSW)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:GYRA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:16 PEVERIL RD
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02921-2422
Mailing Address - Country:US
Mailing Address - Phone:401-497-0587
Mailing Address - Fax:
Practice Address - Street 1:681 RESERVOIR AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-3220
Practice Address - Country:US
Practice Address - Phone:401-943-7186
Practice Address - Fax:401-944-0184
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW015501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI27087-9OtherBLUE CROSS BLUE SHIELD
RI410991OtherBLUE CHIP