Healthcare Provider Details

I. General information

NPI: 1285884072
Provider Name (Legal Business Name): KATHLEEN LA ROCHE LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2008
Last Update Date: 04/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 HOPE ST C/O FAMILY SERVICE OF RHODE ISLAND, INC
PROVIDENCE RI
02906-2001
US

IV. Provider business mailing address

63 GRACE AVE
WARWICK RI
02889-2634
US

V. Phone/Fax

Practice location:
  • Phone: 401-331-1350
  • Fax: 401-277-3366
Mailing address:
  • Phone: 401-921-4166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC00391
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: