Provider Demographics
NPI:1730466160
Name:PATRY, KIERAN DIAN (LCDP)
Entity Type:Individual
Prefix:MRS
First Name:KIERAN
Middle Name:DIAN
Last Name:PATRY
Suffix:
Gender:F
Credentials:LCDP
Other - Prefix:
Other - First Name:KIERAN
Other - Middle Name:DIAN
Other - Last Name:CATLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1950 TOWER HILL RD
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-6628
Mailing Address - Country:US
Mailing Address - Phone:401-294-6160
Mailing Address - Fax:401-295-2513
Practice Address - Street 1:1950 TOWER HILL RD
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-6628
Practice Address - Country:US
Practice Address - Phone:401-294-6160
Practice Address - Fax:401-295-2513
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICDP00494101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
RICDP00494OtherRHODE ISLAND DEPT OF HEALTH