Provider Demographics
NPI:1336259407
Name:KRALICKY, KIMBERLY (LICSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:KRALICKY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WELLS ST
Mailing Address - Street 2:THE WESTERLY HOSPITAL
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-2922
Mailing Address - Country:US
Mailing Address - Phone:401-348-3972
Mailing Address - Fax:401-348-3436
Practice Address - Street 1:25 WELLS ST
Practice Address - Street 2:THE WESTERLY HOSPITAL
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2922
Practice Address - Country:US
Practice Address - Phone:401-348-3972
Practice Address - Fax:401-348-3436
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW015581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI271930OtherBLUE CROSS BLUE SHIELD
RI411723OtherBLUECHIP
RI6299601OtherUNITED BEHAVIORAL HEALTH
Q11330Medicare UPIN
RI6299601OtherUNITED BEHAVIORAL HEALTH