Provider Demographics
NPI:1003301987
Name:GAW, KEVIN FARRELL (PHD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:FARRELL
Last Name:GAW
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 TINGLEY DR
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-4216
Mailing Address - Country:US
Mailing Address - Phone:401-400-1382
Mailing Address - Fax:
Practice Address - Street 1:25 TINGLEY DR
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-4216
Practice Address - Country:US
Practice Address - Phone:401-400-1382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0377103T00000X
RIPS01690103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist