Basic Information
| Provider Information | |||||||||
| NPI: | 1285884072 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LA ROCHE | ||||||||
| FirstName: | KATHLEEN | ||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 63 GRACE AVE | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028892634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4019214166 | ||||||||
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| Practice Location | |||||||||
| Address1: | 55 HOPE ST | ||||||||
| Address2: | C/O FAMILY SERVICE OF RHODE ISLAND, INC | ||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029062001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013311350 | ||||||||
| FaxNumber: | 4012773366 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2008 | ||||||||
| LastUpdateDate: | 04/16/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | MHC00391 | RI | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.