Provider Demographics
NPI:1982907580
Name:QUADROS, KIMBERLY (MASTERS)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:QUADROS
Suffix:
Gender:F
Credentials:MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 ASHBROOK DR
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02921-7502
Mailing Address - Country:US
Mailing Address - Phone:401-219-9115
Mailing Address - Fax:401-475-8851
Practice Address - Street 1:46 ASHBROOK DR
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02921-7502
Practice Address - Country:US
Practice Address - Phone:401-219-9115
Practice Address - Fax:401-475-8851
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-21
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIGH57134Medicaid