Provider Demographics
NPI:1508129388
Name:HATHAWAY, KEVIN I (MHC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:I
Last Name:HATHAWAY
Suffix:
Gender:M
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PARK ROW W APT 635
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-1182
Mailing Address - Country:US
Mailing Address - Phone:401-261-3733
Mailing Address - Fax:
Practice Address - Street 1:10 PARK ROW W APT 635
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-1182
Practice Address - Country:US
Practice Address - Phone:401-261-3733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00531101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health