Provider Demographics
NPI:1760009963
Name:KINSELLA, BRIDGET KELLY (MSW, CGS)
Entity Type:Individual
Prefix:MS
First Name:BRIDGET
Middle Name:KELLY
Last Name:KINSELLA
Suffix:
Gender:F
Credentials:MSW, CGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 ROSENEATH AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-3845
Mailing Address - Country:US
Mailing Address - Phone:401-222-0749
Mailing Address - Fax:
Practice Address - Street 1:420 FRUIT HILL AVE
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02911-2626
Practice Address - Country:US
Practice Address - Phone:401-353-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker