Kelly Elizabeth Deragon, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PS02305 Issued in RI

Practice address

1 Richmond SQ
Providence, RI 02906-5139

Phone

(401) 309-1844

NPI assigned

Jul 9, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in RI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Child and Family Psychiatry, Inc.Group PAC ID 5294173464, 90 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Child and Family Psychiatry, Inc.

  • Psychiatry Physician
  • Warwick, RI
  • NPI 1760863229
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1720483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728518400000",
    "number": "1346087301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 RICHMOND SQ",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029065139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 RICHMOND SQ",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029065139",
            "telephone_number": "401-309-1844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERAGON",
        "first_name": "KELLY",
        "middle_name": "ELIZABETH",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-09",
        "last_updated": "2024-10-10",
        "certification_date": "2024-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "RI",
            "license": "PS02305",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joelle Anne Therese Depeyrot, LICSW
• Marissa Lynn Depietro, FNP
• Rachel M Depner, PHD
• Daniel Depolo, MD
• Judith D. Depue, EDD
• Deride LLC
• Giosi Derleth Vitale, APRN CNP
• Diane Dermarderosian, MD
• Dennis Paul Derocher, DC
• Stacey Deros

• Clinical Psychologist in Providence, RI
• Providers in Providence, RI by specialty
• Clinical Psychologist in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.