Healthcare Provider Details

I. General information

NPI: 1487158879
Provider Name (Legal Business Name): KRISTEN R. GANGEMI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 POINT JUDITH RD # 23
NARRAGANSETT RI
02882-3477
US

IV. Provider business mailing address

140 POINT JUDITH RD # 23
NARRAGANSETT RI
02882-3477
US

V. Phone/Fax

Practice location:
  • Phone: 401-258-4437
  • Fax: 401-237-0988
Mailing address:
  • Phone: 401-250-2731
  • Fax: 401-386-3443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDP01093
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCSW02807
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: