Provider Demographics
NPI:1962471391
Name:KIDD, RONALD V (PHD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:V
Last Name:KIDD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3987 E PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-2784
Mailing Address - Country:US
Mailing Address - Phone:757-873-1736
Mailing Address - Fax:757-873-1028
Practice Address - Street 1:1318 JAMESTOWN RD STE 101
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-3382
Practice Address - Country:US
Practice Address - Phone:757-645-4715
Practice Address - Fax:757-645-4720
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21133103T00000X
VA0810003230103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist