Healthcare Provider Details

I. General information

NPI: 1922672948
Provider Name (Legal Business Name): KATHERINE MARIE PESCOSOLIDO PHD, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2021
Last Update Date: 05/14/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 POST RD
WARWICK RI
02888-3363
US

IV. Provider business mailing address

1035 POST RD
WARWICK RI
02888-3363
US

V. Phone/Fax

Practice location:
  • Phone: 401-785-0040
  • Fax:
Mailing address:
  • Phone: 401-785-0040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC01228
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: