Healthcare Provider Details

I. General information

NPI: 1528461027
Provider Name (Legal Business Name): KRISTEN KOCHANSKI PHD, MSCP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2014
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 SMITH RD
NEWPORT RI
02841-1006
US

IV. Provider business mailing address

43 SMITH RD
NEWPORT RI
02841-1006
US

V. Phone/Fax

Practice location:
  • Phone: 401-841-1919
  • Fax:
Mailing address:
  • Phone: 401-841-1919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.010578
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810005106
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number074.000009
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: