Healthcare Provider Details

I. General information

NPI: 1679191498
Provider Name (Legal Business Name): ALLISON KILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 ATWELLS AVE STE D201
PROVIDENCE RI
02909-7421
US

IV. Provider business mailing address

623 ATWELLS AVENUE SUITE 201D
PROVIDENCE RI
02909-2400
US

V. Phone/Fax

Practice location:
  • Phone: 401-861-2680
  • Fax:
Mailing address:
  • Phone: 401-378-1090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW04156
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW1141033
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: