Provider Demographics
NPI:1801800115
Name:LEVY, KATHLEEN (MS LMFT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:LEVY
Suffix:
Gender:F
Credentials:MS LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 WILD FLOWER TRL
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-1437
Mailing Address - Country:US
Mailing Address - Phone:401-788-9500
Mailing Address - Fax:401-788-9500
Practice Address - Street 1:24 SALT POND RD STE B4
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-4320
Practice Address - Country:US
Practice Address - Phone:401-788-9500
Practice Address - Fax:401-788-9500
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI054106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI22379-7OtherBLUE CROSS BLUE SHIELD RI
RI62-51957OtherUNITED HEALTH CARE
RIKL56146Medicaid