Provider Demographics
NPI:1467515957
Name:SOUTH COUNTY CHILD & FAMILY CONSULTANTS
Entity Type:Organization
Organization Name:SOUTH COUNTY CHILD & FAMILY CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:I. RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:KULMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:401-789-1553
Mailing Address - Street 1:1058 KINGSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:PEACE DALE
Mailing Address - State:RI
Mailing Address - Zip Code:02879-2487
Mailing Address - Country:US
Mailing Address - Phone:401-789-1553
Mailing Address - Fax:401-782-1313
Practice Address - Street 1:1058 KINGSTOWN RD
Practice Address - Street 2:
Practice Address - City:PEACE DALE
Practice Address - State:RI
Practice Address - Zip Code:02879-2487
Practice Address - Country:US
Practice Address - Phone:401-789-1553
Practice Address - Fax:401-782-1313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00313103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIRK02108Medicaid