Healthcare Provider Details

I. General information

NPI: 1154568178
Provider Name (Legal Business Name): JENNIFER KILROY LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER MASTERS

II. Dates (important events)

Enumeration Date: 01/13/2009
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

989 RESERVOIR AVE STE 101
CRANSTON RI
02910-5138
US

IV. Provider business mailing address

4800 N SCOTTSDALE RD STE 2500
SCOTTSDALE AZ
85251-7630
US

V. Phone/Fax

Practice location:
  • Phone: 401-572-3313
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC00386
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: