Provider Demographics
NPI:1235185034
Name:O'CONNELL, KRISTEN (LMHC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 KINGSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:RI
Mailing Address - Zip Code:02898-1101
Mailing Address - Country:US
Mailing Address - Phone:401-481-6217
Mailing Address - Fax:401-481-6217
Practice Address - Street 1:49 PAVILION AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-1534
Practice Address - Country:US
Practice Address - Phone:401-490-8930
Practice Address - Fax:401-490-8930
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00180101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIKM46155Medicaid