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General NPI Number Information
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NPI Number | 1780713735
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Entity Type | Individual
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Provider Name | KELLEY HARRISON PISTACCHIO PH.D
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Gender | Female
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 610 MANTON AVE
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City | PROVIDENCE
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State | RI
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Zip | 02909-5633
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Country | US
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Telephone | 401-274-6310
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Fax | 401-421-1977
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Provider Business Mailing Address
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Address Line | 122 JANE ST
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City | NORTH PROVIDENCE
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State | RI
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Zip | 02904-4957
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Country | US
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Telephone | 401-274-6310
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Fax | 401-421-1977
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS00680
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | PS00680
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License Number State | RI
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS00680
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License Number State | RI
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Taxonomy #4
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PS00680
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License Number State | RI
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Taxonomy #5
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number | PS00680
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License Number State | RI
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Taxonomy #6
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number | PS00680
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License Number State | RI
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