Provider Demographics
NPI:1407582406
Name:DONNELLY, KAYLA L
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:L
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 ELEANOR DR
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-7710
Mailing Address - Country:US
Mailing Address - Phone:401-648-1560
Mailing Address - Fax:
Practice Address - Street 1:1 RICHMOND SQ STE 305W
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5141
Practice Address - Country:US
Practice Address - Phone:401-227-0372
Practice Address - Fax:877-455-9466
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW027601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical