Provider Demographics
NPI:1598884298
Name:ASCOLI, KEVIN DAVID (LICSW)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:DAVID
Last Name:ASCOLI
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 CADORNA ST
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-2102
Mailing Address - Country:US
Mailing Address - Phone:401-434-1654
Mailing Address - Fax:
Practice Address - Street 1:1087 WARWICK AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-3545
Practice Address - Country:US
Practice Address - Phone:401-461-6676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW017281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical