Provider Demographics
NPI:1407905607
Name:DEL RIO, KATHLEEN L (MS)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:L
Last Name:DEL RIO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 COMMERCIAL WHARF
Mailing Address - Street 2:#65
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-0343
Mailing Address - Country:US
Mailing Address - Phone:401-849-1459
Mailing Address - Fax:
Practice Address - Street 1:42 SPRING STREET
Practice Address - Street 2:#13
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-3043
Practice Address - Country:US
Practice Address - Phone:401-842-0090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC 00309101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health