Provider Demographics
NPI:1811695059
Name:KATHLEEN TRELOAR LICSW LLC
Entity type:Organization
Organization Name:KATHLEEN TRELOAR LICSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRELOAR
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:401-419-7267
Mailing Address - Street 1:1051 TEN ROD RD UNIT 5A
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-4163
Mailing Address - Country:US
Mailing Address - Phone:401-419-7267
Mailing Address - Fax:
Practice Address - Street 1:1051 TEN ROD RD UNIT 5A
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-4163
Practice Address - Country:US
Practice Address - Phone:401-419-7267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-17
Last Update Date:2023-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty