# TIMOTHY KIERAN RIDGE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1609083823
- **Gender:** Man
- **Credential:** LMFT

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | MFT00110 | RI | Yes |

## Other

- **Enumeration date:** 05/17/2007
- **Last updated:** 12/27/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 326867 | BLUE CROSS BLUE SHIELD | RI |
| 01 | — | 414012 | BLUE CHIP | RI |
| 05 | — | TR66767 | — | RI |