Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PS00884 | RI |
Y | 103T00000X | Psychologist | PS00884 | RI |
NPI | 1003869876 |
---|---|
Provider Name | Samantha A. Kirk |
First Address | Cranston, RI 02905-1336 |
Second Address | Cranston, RI 02905-1336 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 08/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
SK56341 | (05) | RI |