Provider Demographics
NPI:1962239566
Name:BIONDOLILLO, KEVIN (PSYD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:BIONDOLILLO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 ROLENS DR APT A2
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02881-1738
Mailing Address - Country:US
Mailing Address - Phone:585-694-8703
Mailing Address - Fax:
Practice Address - Street 1:30 ROLENS DR APT A2
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:RI
Practice Address - Zip Code:02881-1738
Practice Address - Country:US
Practice Address - Phone:585-694-8703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPST00330103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist