Healthcare Provider Details

I. General information

NPI: 1538138482
Provider Name (Legal Business Name): KRISTIN M AYLWARD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 PINE ST
FALL RIVER MA
02720
US

IV. Provider business mailing address

145 GOVERNOR ST
PROVIDENCE RI
02906
US

V. Phone/Fax

Practice location:
  • Phone: 508-678-0041
  • Fax: 508-324-9002
Mailing address:
  • Phone: 401-351-5253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number211351
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number113873
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier211351
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerLICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: