Healthcare Provider Details

I. General information

NPI: 1124754775
Provider Name (Legal Business Name): IAN A KIRKWOOD MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 N MAIN ST
PROVIDENCE RI
02904-5762
US

IV. Provider business mailing address

243 FREMONT ST
TAUNTON MA
02780-1277
US

V. Phone/Fax

Practice location:
  • Phone: 401-274-2500
  • Fax:
Mailing address:
  • Phone: 508-813-8860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: