Provider Demographics
NPI:1477166692
Name:FARRELL, KAYLA (LICSW)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:FARRELL
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 1:50 WILLIAMS AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-3509
Mailing Address - Country:US
Mailing Address - Phone:401-400-1226
Mailing Address - Fax:
Practice Address - Street 1:525 BRANCH AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-2287
Practice Address - Country:US
Practice Address - Phone:401-400-1226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-27
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW024151041C0700X
RIISW038551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIISW0385OtherLICSW