Provider Demographics
NPI:1881727394
Name:CASSANI, KELLY (ELI)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:
Last Name:CASSANI
Suffix:
Gender:F
Credentials:ELI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40937
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02940-0937
Mailing Address - Country:US
Mailing Address - Phone:401-725-7922
Mailing Address - Fax:401-726-8834
Practice Address - Street 1:33 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-6121
Practice Address - Country:US
Practice Address - Phone:401-725-7922
Practice Address - Fax:401-726-8834
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIELI-0073171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator