Healthcare Provider Details

I. General information

NPI: 1326432808
Provider Name (Legal Business Name): KYLE CHOQUETTE BA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 03/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 DIAMOND HILL RD
WOONSOCKET RI
02895-1771
US

IV. Provider business mailing address

1625 DIAMOND HILL RD
WOONSOCKET RI
02895-1771
US

V. Phone/Fax

Practice location:
  • Phone: 401-762-1511
  • Fax: 401-762-1609
Mailing address:
  • Phone: 401-762-1511
  • Fax: 401-762-1609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: