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General NPI Number Information
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NPI Number | 1104919117
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Entity Type | Individual
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Provider Name | KELLI RIVELLI LICSW
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Gender | Female
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 1126 HARTFORD AVE SUITE 101
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City | JOHNSTON
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State | RI
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Zip | 02919-7130
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Country | US
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Telephone | 401-351-2750
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Fax | 401-351-7002
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Provider Business Mailing Address
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Address Line | 1126 HARTFORD AVE SUITE 101
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City | JOHNSTON
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State | RI
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Zip | 02919-7130
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Country | US
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Telephone | 401-351-2750
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Fax | 401-351-7002
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | L.C.D.P. # NOT RCVD
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ISW04259
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License Number State | RI
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