Provider Demographics
NPI:1528123478
Name:CARTY, KATHLEENN ANN (PHD, MSW, LICSW)
Entity type:Individual
Prefix:DR
First Name:KATHLEENN
Middle Name:ANN
Last Name:CARTY
Suffix:
Gender:F
Credentials:PHD, MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1JAMES P. MURPHY HIGHWAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WEST WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02893
Mailing Address - Country:US
Mailing Address - Phone:401-615-0648
Mailing Address - Fax:401-615-9540
Practice Address - Street 1:1JAMES P. MURPHY HIGHWAY
Practice Address - Street 2:SUITE 103
Practice Address - City:WEST WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02893
Practice Address - Country:US
Practice Address - Phone:401-615-0648
Practice Address - Fax:401-615-9540
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW01152101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI406247OtherBLUE CHIP
RI20876-7OtherBLUE CROSS BLUE SHIELD