Provider Demographics
NPI:1124060439
Name:DIMINO, KENDRA (LICSW)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:DIMINO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:
Other - Last Name:CORRIVEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:935 PARK AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-2748
Mailing Address - Country:US
Mailing Address - Phone:401-439-0329
Mailing Address - Fax:401-228-3030
Practice Address - Street 1:935 PARK AVE STE 206
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-2748
Practice Address - Country:US
Practice Address - Phone:401-439-0329
Practice Address - Fax:401-228-3030
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW014301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI29289-6OtherBLUE SHIELD PROVIDER #
RI412739OtherBLUE CHIP PROVIDER #