Provider Demographics
NPI:1972708287
Name:DAVID, KRISTIN ANNE (PSYD)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ANNE
Last Name:DAVID
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 WARWICK AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-3665
Mailing Address - Country:US
Mailing Address - Phone:401-465-2670
Mailing Address - Fax:401-270-0660
Practice Address - Street 1:1045 WARWICK AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-3665
Practice Address - Country:US
Practice Address - Phone:401-465-2670
Practice Address - Fax:401-270-0660
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS01014103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist