Provider Demographics
NPI:1700091287
Name:WALDRON, KELLY MCCABE (MA, CAGS, LMHC)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:MCCABE
Last Name:WALDRON
Suffix:
Gender:F
Credentials:MA, CAGS, LMHC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:MCCABE
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:24 FIELDSTONE DRIVE
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816
Mailing Address - Country:US
Mailing Address - Phone:401-952-8188
Mailing Address - Fax:401-385-9410
Practice Address - Street 1:24 FIELDSTONE DRIVE
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816
Practice Address - Country:US
Practice Address - Phone:401-952-8188
Practice Address - Fax:401-385-9410
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
RIMHC00333101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health