Healthcare Provider Details

I. General information

NPI: 1396608907
Provider Name (Legal Business Name): KEVIN OAKLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 HOPE ST
PROVIDENCE RI
02906-2001
US

IV. Provider business mailing address

27 NEW BRITAIN DR
WARWICK RI
02889-3233
US

V. Phone/Fax

Practice location:
  • Phone: 401-331-1350
  • Fax: 401-277-3385
Mailing address:
  • Phone: 401-441-8136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: