Healthcare Provider Details

I. General information

NPI: 1679189310
Provider Name (Legal Business Name): KATHLEEN M TOKARSKI LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATE TOKARSKI LICSW

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 09/18/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 BROAD ST STE B
WESTERLY RI
02891-1977
US

IV. Provider business mailing address

43 BROAD ST STE B
WESTERLY RI
02891-1977
US

V. Phone/Fax

Practice location:
  • Phone: 401-596-2302
  • Fax:
Mailing address:
  • Phone: 401-596-5302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW01551
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: