KELLY LEVESQUE (NPI# 1679877906) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679877906 |
| Entity Type | Individual |
| Full Name | KELLY LEVESQUE |
| Credential | LCDP |
| Practice Address |
166 Pawtucket Ave Pawtucket RI 02860-3811 |
| Practice Telephone | 4017224644 |
| Practice Fax Number | 4017225039 |
| Mailing Telephone | 4017224644 |
| Mailing Fax Number | 4017225039 |
| Enumeration Date | 2010-12-30 |
| Last Update Date | 2010-12-30 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
CDP00429 | RI | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| RI | GH57134 | 05 |
| Street Address |
166 PAWTUCKET AVE |
| City | PAWTUCKET |
| State | RI |
| Zip Code | 02860-3811 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194828749 | Meredith M Denno | Counselor | 166 Pawtucket Ave, Pawtucket, RI 02860 | 2006-09-07 |
| 1437784253 | Robin Lee Young | Counselor | 166 Pawtucket Ave, Pawtucket, RI 02860-3811 | 2020-03-12 |
| 1417429788 | Tami Rene Jarvis | Counselor | 166 Pawtucket Ave, Pawtucket, RI 02860-3811 | 2018-12-26 |
| 1376955609 | Donna Renshaw | Counselor | 166 Pawtucket Ave, Pawtucket, RI 02860-3811 | 2014-05-21 |
| 1770837734 | Jackie Berry | Counselor | 166 Pawtucket Ave, Pawtucket, RI 02860-3811 | 2012-10-30 |
| 1528208055 | Jody Skaggs | Counselor | 166 Pawtucket Ave, Pawtucket, RI 02860-3811 | 2009-02-24 |
| 1285766584 | Caritas Inc. | Clinic/Center | 166 Pawtucket Ave, Pawtucket, RI 02860-3811 | 2007-03-12 |
| 1265594774 | Carolynne C Davis | Counselor | 166 Pawtucket Ave, Pawtucket, RI 02860-3811 | 2006-12-14 |
| 1871684688 | Dianne Gee Shuttlesworth | Counselor | 166 Pawtucket Ave, Pawtucket, RI 02860-3811 | 2006-09-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972096923 | Lmb Medical LLC | Internal Medicine | 127 School St, Pawtucket, RI 02860 | 2018-06-13 |
| 1215420435 | Tyla Jackson | Behavior Technician | 70 Wood St Apt 22, Pawtucket, RI 02860 | 2018-06-12 |
| 1376048637 | Michael A Iadevaia | Family Medicine | 111 Brewster St Fl 3, Pawtucket, RI 02860 | 2018-03-28 |
| 1730690488 | Anthony Edwin Ramicone | Physician Assistant | 407 East Ave Ste 120, Pawtucket, RI 02860 | 2017-10-21 |
| 1669991352 | Kathleen K. Kroessler, Md; Neurology & Acupuncture, Inc. PC | Clinic/Center | 407 East Ave; Suite 110, Pawtucket, RI 02860 | 2017-09-13 |
| 1841716230 | Ri Alternative Academy Management, LLC | Local Education Agency (LEA) | 249 Roosevelt Avenue, Pawtucket, RI 02860 | 2017-08-17 |
| 1396265724 | Hannah R Stoops | Family Medicine | 111 Brewster St Fcc A, Pawtucket, RI 02860 | 2017-06-27 |
| 1427578400 | Shaun Michael Flynn | Family Medicine | 111 Brewster St, Fcc A, Pawtucket, RI 02860 | 2017-06-21 |
| 1073051843 | Laura Jane Amaral | Counselor | 750 East Ave Unit 1e, Pawtucket, RI 02860 | 2017-02-01 |
| 1063862027 | Stephanie Shoppell | Counselor | 105 Bacon Street, Pawtucket, RI 02860 | 2016-06-20 |
| Find all providers in zip 02860 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831741156 | Lauren D'andrea | Counselor | 50 Tobie Ave, Pawtucket, RI 02861-2912 | 2019-07-16 |
| 1073051843 | Laura Jane Amaral | Counselor | 750 East Ave Unit 1e, Pawtucket, RI 02860 | 2017-02-01 |
| 1760929012 | Taylor Alexis Daddario | Counselor | 57 Charlton Ave, Pawtucket, RI 02860-6233 | 2017-01-25 |
| 1164887444 | Lori-ann Tetreault | Counselor | 15 Woodhaven Rd, Pawtucket, RI 02861-3530 | 2015-12-30 |
| 1285018077 | David Lussier | Counselor | 80 Summit St, Pawtucket, RI 02860-4206 | 2015-07-13 |
| 1053533182 | Janet Hindley | Counselor | 115 Hanover Ave, Pawtucket, RI 02861-2129 | 2007-05-02 |
| 1447475074 | Robin N. Pierce-pacheco | Counselor | 31 North Union Street, Pawtucket, RI 02860 | 2007-04-17 |
| 1447375662 | Susan D. Wallace | Counselor | 166 Pawtucket Avenue, Pawtucket, RI 02860-3811 | 2007-03-20 |
| 1649300765 | Geovany Orrego | Counselor | 101 Bacon St # 103, Pawtucket, RI 02860-5542 | 2007-03-07 |
| 1194828749 | Meredith M Denno | Counselor | 166 Pawtucket Ave, Pawtucket, RI 02860 | 2006-09-07 |
| Find all providers in PAWTUCKET | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.