Healthcare Provider Details

I. General information

NPI: 1720911431
Provider Name (Legal Business Name): SIDNEY KWIRAM LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDWAY ST
PROVIDENCE RI
02906-4402
US

IV. Provider business mailing address

24 BRUSH HILL RD
NARRAGANSETT RI
02882-4304
US

V. Phone/Fax

Practice location:
  • Phone: 401-421-4100
  • Fax:
Mailing address:
  • Phone: 206-910-0344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW04187
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: