Healthcare Provider Details

I. General information

NPI: 1174443865
Provider Name (Legal Business Name): KAE WINTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 HARVARD AVE
WARWICK RI
02889-2115
US

IV. Provider business mailing address

15 HARVARD AVE
WARWICK RI
02889-2115
US

V. Phone/Fax

Practice location:
  • Phone: 401-558-8008
  • Fax:
Mailing address:
  • Phone: 401-558-8008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. KELLI LAVALLEE
Title or Position: SOLE PROPRIETER
Credential: LMHC
Phone: 401-558-8008