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General NPI Number Information
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NPI Number | 1790564581
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Entity Type | Individual
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Provider Name | KIMBERLY PRISTAWA NCSP
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Gender | Female
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Dates
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Enumeration Date | 09/21/2023
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Last Update Date | 09/21/2023
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Provider Practice Location Address
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Address Line | 425 EAST AVE
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City | HARRISVILLE
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State | RI
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Zip | 02830-1506
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Country | US
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Telephone | 401-568-1310
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Fax |
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Provider Business Mailing Address
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Address Line | 30 CAROL DR
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City | HARRISVILLE
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State | RI
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Zip | 02830-1836
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Country | US
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Telephone | 401-226-5068
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 23852
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License Number State | RI
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