Healthcare Provider Details

I. General information

NPI: 1295991586
Provider Name (Legal Business Name): KATHLEEN GARLICK PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 10/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705 OLD POST RD
CHARLESTOWN RI
02813-1819
US

IV. Provider business mailing address

1157 SOUTH RD
WAKEFIELD RI
02879-7633
US

V. Phone/Fax

Practice location:
  • Phone: 401-364-7705
  • Fax: 401-783-2558
Mailing address:
  • Phone: 401-789-1367
  • Fax: 401-783-2558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDP00708
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: