Healthcare Provider Details

I. General information

NPI: 1134479520
Provider Name (Legal Business Name): KIMBERLY MARY COTE LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2078 WALLUM LAKE RD.
PASCOAG RI
02859
US

IV. Provider business mailing address

9 SANDY LN
HARRISVILLE RI
02830-1343
US

V. Phone/Fax

Practice location:
  • Phone: 401-568-1770
  • Fax:
Mailing address:
  • Phone: 401-527-9637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW02250
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: