Healthcare Provider Details

I. General information

NPI: 1528123478
Provider Name (Legal Business Name): KATHLEENN ANN CARTY PHD, MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1JAMES P. MURPHY HIGHWAY SUITE 103
WEST WARWICK RI
02893
US

IV. Provider business mailing address

1JAMES P. MURPHY HIGHWAY SUITE 103
WEST WARWICK RI
02893
US

V. Phone/Fax

Practice location:
  • Phone: 401-615-0648
  • Fax: 401-615-9540
Mailing address:
  • Phone: 401-615-0648
  • Fax: 401-615-9540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberISW01152
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: