MEDICARE: KATHLEEN TRELOAR LICSW LLC

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	261QM0850X	Adult Mental Health Clinic/Center
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1811695059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATHLEEN TRELOAR LICSW LLC

Provider Business Mailing Address
First Line	:	1051 TEN ROD RD UNIT 5A
Second Line	:
City	:	NORTH KINGSTOWN
State	:	RI
Zip	:	02852-4163
Country	:	US
Telephone Number	:	401-419-7267
Fax Number	:

Provider Business Practice Location Address
First Line	:	1051 TEN ROD RD UNIT 5A
Second Line	:
City	:	NORTH KINGSTOWN
State	:	RI
Zip	:	02852-4163
Country	:	US
Telephone Number	:	401-419-7267
Fax Number	:

Authorized Official
Title or Position	:	OWNER CLINICAL THERAPIST
Name	:	KATHLEEN TRELOAR
Credential	:	LICSW
Telephone Number	:	401-419-7267

Provider Enumeration Date	:	02/17/2023
Last Update Date	:	03/25/2026

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