Basic Information
| Provider Information | |||||||||
| NPI: | 1558511105 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KANE | ||||||||
| FirstName: | BONNIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 128 ABEL HART LN | ||||||||
| Address2: | |||||||||
| City: | TIVERTON | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028782792 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018160968 | ||||||||
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| Practice Location | |||||||||
| Address1: | 55 HOPE ST | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029062001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013311350 | ||||||||
| FaxNumber: | 4012773366 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2008 | ||||||||
| LastUpdateDate: | 09/19/2008 | ||||||||
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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 | 103TC0700X | PS01086 | RI | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 1021740 | 01 | NHP GROUP | OTHER |