Provider Demographics
NPI:1821655226
Name:CHAPMAN, KIMBERLY ROSE (PHD)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ROSE
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 W RIVER ST STE 11A
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-2609
Mailing Address - Country:US
Mailing Address - Phone:401-793-4006
Mailing Address - Fax:401-793-4002
Practice Address - Street 1:146 W RIVER ST STE 11A
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-2609
Practice Address - Country:US
Practice Address - Phone:401-793-4006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 103G00000X
RIPS02132103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist