Provider Demographics
NPI:1912383142
Name:MIHALICH, KELLY ANN (MED, BCBA, LABA)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ANN
Last Name:MIHALICH
Suffix:
Gender:F
Credentials:MED, BCBA, LABA
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:ANN
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:215 TOLL GATE RD STE 309
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4463
Mailing Address - Country:US
Mailing Address - Phone:401-310-2220
Mailing Address - Fax:
Practice Address - Street 1:215 TOLL GATE RD STE 309
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4463
Practice Address - Country:US
Practice Address - Phone:401-310-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2482103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst