Individual
DR. SUSANNAH KONDRATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
830 CHALKSTONE AVE, PROVIDENCE, RI 02908-4734
(401) 273-7100
Mailing address
11 EAGLE ST UNIT 222, PROVIDENCE, RI 02908-5642
(781) 710-1468
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS01867
RI
Other
Enumeration date
06/18/2020
Last updated
06/18/2020
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