Healthcare Provider Details

I. General information

NPI: 1245240613
Provider Name (Legal Business Name): KATHE A JARET PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 NORTH RD
PEACE DALE RI
02879-2176
US

IV. Provider business mailing address

23 NORTH RD
PEACE DALE RI
02879-2176
US

V. Phone/Fax

Practice location:
  • Phone: 401-789-8244
  • Fax:
Mailing address:
  • Phone: 401-789-8244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number401
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: