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Individual
TIMOTHY KIERAN RIDGE
Active
Individual
TIMOTHY KIERAN RIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMFT
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
MFT00110
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
326867
BLUE CROSS BLUE SHIELD
RI
01
—
414012
BLUE CHIP
RI
05
—
TR66767
—
RI
Enumeration date
05/17/2007
Last updated
12/27/2007
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