Individual
DR. KELLEY HARRISON PISTACCHIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D
Contact information
Practice address
610 MANTON AVE, PROVIDENCE, RI 02909-5633
(401) 274-6310
(401) 421-1977
Mailing address
122 JANE ST, NORTH PROVIDENCE, RI 02904-4957
(401) 274-6310
(401) 421-1977
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
PS00680
RI
103TB0200X
Cognitive & Behavioral Psychologist
PS00680
RI
103TC0700X
Clinical Psychologist
PS00680
RI
103TC2200X
Clinical Child & Adolescent Psychologist
PS00680
RI
103TM1800X
Intellectual & Developmental Disabilities Psychologist
PS00680
RI
103TP2701X
Group Psychotherapy Psychologist
Primary
PS00680
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30189-1
BLUE CROSS
RI
01
—
410468
BLUE CHIP
RI
01
—
61-00006
UNITED BEHAVIORAL HEALTH
RI
05
—
KH29823
—
RI
Enumeration date
03/05/2007
Last updated
09/11/2025
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