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General NPI Number Information
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NPI Number | 1518188432
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Entity Type | Individual
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Provider Name | KATHRYN NICODEMUS LICSW
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Gender | Female
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 19 VALLEY RD
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City | MIDDLETOWN
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State | RI
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Zip | 02842-6306
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Country | US
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Telephone | 401-845-2269
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Fax | 401-848-4192
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Provider Business Mailing Address
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Address Line | 31 LOWDEN ST
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City | PAWTUCKET
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State | RI
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Zip | 02860-6123
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Country | US
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Telephone | 401-723-6232
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ISW00633
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License Number State | RI
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