MEDICARE: KATHLEEN L DEL RIO MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MHC 00309	RI

General Provider Information

NPI Number	:	1407905607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN L DEL RIO MS

Provider Business Mailing Address
First Line	:	1 COMMERCIAL WHARF
Second Line	:	#65
City	:	NEWPORT
State	:	RI
Zip	:	02840-0343
Country	:	US
Telephone Number	:	401-849-1459
Fax Number	:

Provider Business Practice Location Address
First Line	:	42 SPRING STREET
Second Line	:	#13
City	:	NEWPORT
State	:	RI
Zip	:	02840-3043
Country	:	US
Telephone Number	:	401-842-0090
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	07/08/2007

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