Provider Demographics
NPI:1407198237
Name:KANEPSYCH, LLC
Entity Type:Organization
Organization Name:KANEPSYCH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-743-5192
Mailing Address - Street 1:355 HOPE ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-1633
Mailing Address - Country:US
Mailing Address - Phone:401-262-0229
Mailing Address - Fax:401-432-6500
Practice Address - Street 1:355 HOPE ST
Practice Address - Street 2:UNIT 1
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-1633
Practice Address - Country:US
Practice Address - Phone:401-262-0229
Practice Address - Fax:401-432-6500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00534101YM0800X
RIMD124682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty