Provider Demographics
NPI:1265937320
Name:DESMOND, COLLEEN (LICSW)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:DESMOND
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:HAYES-COSTELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:10 STEPHEN DR
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:RI
Mailing Address - Zip Code:02809-4557
Mailing Address - Country:US
Mailing Address - Phone:401-662-7371
Mailing Address - Fax:
Practice Address - Street 1:10 STEPHEN DR
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:RI
Practice Address - Zip Code:02809-4557
Practice Address - Country:US
Practice Address - Phone:401-662-7371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-29
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW02121101Y00000X
1041C0700X
RIISW03197101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical