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General NPI Number Information
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NPI Number | 1538586979
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Entity Type | Individual
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Provider Name | KIMBERLY RODRIGUES LICSW
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Gender | Female
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Dates
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Enumeration Date | 03/24/2014
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Last Update Date | 12/20/2022
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Provider Practice Location Address
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Address Line | 1011 VETERANS MEMORIAL PKWY
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City | RIVERSIDE
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State | RI
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Zip | 02915-5061
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Country | US
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Telephone | 401-432-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 15 PALMER AVE
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City | RIVERSIDE
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State | RI
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Zip | 02915-1724
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Country | US
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Telephone | 401-699-7891
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | ISW02636
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License Number State | RI
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