Individual
M. RAQUEL KENYON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
530 N MAIN ST, PROVIDENCE, RI 02904-5762
(401) 274-2500
Mailing address
528 N MAIN ST, PROVIDENCE, RI 02904-5757
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
ISW01957
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104847946
THE PROVIDENCE CENTER NPI
RI
01
—
1609819457
UBH
RI
05
—
MK51540
—
RI
Enumeration date
06/13/2006
Last updated
03/30/2009
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