Provider Demographics
NPI:1144573742
Name:HARRIS, KIMBERLY (LCSW, MSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 BELLMAN AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02889-2834
Mailing Address - Country:US
Mailing Address - Phone:401-837-1118
Mailing Address - Fax:
Practice Address - Street 1:263 BELLMAN AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02889-2834
Practice Address - Country:US
Practice Address - Phone:401-837-1118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW014801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical