Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | ISW01936 | RI |
NPI | 1003061144 |
---|---|
Provider Name | Kelly Baraf |
First Address | Pawtucket, RI 02860-6122 |
Second Address | Providence, RI 02905-1534 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2008 |
Last Update Date | 03/09/2013 |