Healthcare Provider Details

I. General information

NPI: 1447713680
Provider Name (Legal Business Name): KATE M GUTHRIE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 04/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 WAMPANOAG TRL
RIVERSIDE RI
02915-2232
US

IV. Provider business mailing address

52 LAFAYETTE ST
PAWTUCKET RI
02860-6122
US

V. Phone/Fax

Practice location:
  • Phone: 401-649-4070
  • Fax:
Mailing address:
  • Phone: 401-580-2217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS00642
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: