Provider Demographics
NPI:1568528107
Name:KANE, MICHAEL H (LICSW ACSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:H
Last Name:KANE
Suffix:
Gender:M
Credentials:LICSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 MOORLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02905
Mailing Address - Country:US
Mailing Address - Phone:401-954-1310
Mailing Address - Fax:
Practice Address - Street 1:277 WATERMAN STREET
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906
Practice Address - Country:US
Practice Address - Phone:401-331-7777
Practice Address - Fax:401-751-6241
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILSW002421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI251277OtherBLUE CROSS BLUE SHIELD
RI400574OtherBLUE CHIP