Provider Demographics
NPI:1619026820
Name:BOYD, KATHLEEN EVEN (MSW)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:EVEN
Last Name:BOYD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RICHMOND SQ
Mailing Address - Street 2:SUITE 122C
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5139
Mailing Address - Country:US
Mailing Address - Phone:401-454-2890
Mailing Address - Fax:401-351-8020
Practice Address - Street 1:1 RICHMOND SQ
Practice Address - Street 2:SUITE 122C
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5139
Practice Address - Country:US
Practice Address - Phone:401-454-2890
Practice Address - Fax:401-351-8020
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW003181041C0700X
MA10157351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical