Healthcare Provider Details

I. General information

NPI: 1265937320
Provider Name (Legal Business Name): COLLEEN DESMOND LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: COLLEEN HAYES-COSTELLO LICSW

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 STEPHEN DR
BRISTOL RI
02809-4557
US

IV. Provider business mailing address

10 STEPHEN DR
BRISTOL RI
02809-4557
US

V. Phone/Fax

Practice location:
  • Phone: 401-662-7371
  • Fax:
Mailing address:
  • Phone: 401-662-7371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW03197
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: