Provider Demographics
NPI:1841423084
Name:RAVENSCROFT, KELLY ANN (BA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:RAVENSCROFT
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-3123
Mailing Address - Country:US
Mailing Address - Phone:401-766-0900
Mailing Address - Fax:401-767-4099
Practice Address - Street 1:245 MAIN ST
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-3123
Practice Address - Country:US
Practice Address - Phone:401-766-0900
Practice Address - Fax:401-767-4099
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor