Individual provider Active NPI

Kristy Lee Dalrymple, PH.D.

  • Clinical Psychologist
  • Providence, RI
National Provider Identifier
1750579355
Registry record updated Mar 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PS01032 Issued in RI
Practice address
146 W River St
Suite 11B
Providence, RI 02904-2609
Phone
(401) 444-7442
Fax
(401) 444-7109
NPI assigned
Oct 9, 2007
Last updated
Mar 17, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PS01032 RI
Clinical Psychologist 103TC0700X PS01032 RI Primary

Addresses

Primary practice location

146 W River St
Suite 11B
Providence, RI 02904-2609

Mailing address

117 Ellenfield St # 101
Providence, RI 02905-4513
Phone (401) 444-4318

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20071220000649 RI Practitioner - Clinical Psychologist 1153411665 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lifespan Physician Group IncGroup PAC ID 2567455082, 1,151 clinicians

Practice addresses (Care Compare)

593 Eddy St
Providence, RI 02903-4923
Phone (401) 444-6779

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PS01032RIMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
The Miriam Hospital Clinical CurrentSince Mar 7, 2020 Accepting new patients
The Miriam Hospital CurrentSince Mar 7, 2020 Accepting new patients
Lifespan Physician Group, Inc. Psychologist CurrentSince Apr 17, 2013 Accepting new patients
Lifespan Physician Group, Inc. CurrentSince Apr 17, 2013 Accepting new patients

Locations

117 Ellenfield St
Ste 101
Providence, RI 02905
Phone (401) 444-4318

146 W River St
Ste 11B
Providence, RI 02904
Phone (401) 444-7442

164 Summit Ave
Providence, RI 02906
Phone (401) 793-2104

235 Plain St
Ste 501
Providence, RI 02905
Phone (401) 277-0701

593 Eddy St
Providence, RI 02903

593 Eddy St
Rm 38
Providence, RI 02903
Phone (401) 444-4779

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1191888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458172800000",
    "number": "1750579355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 ELLENFIELD ST # 101",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029054513",
            "telephone_number": "401-444-4318",
            "fax_number": "401-444-6912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "146 W RIVER ST",
            "address_2": "SUITE 11B",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029042609",
            "telephone_number": "401-444-7442",
            "fax_number": "401-444-7109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DALRYMPLE",
        "first_name": "KRISTY",
        "middle_name": "LEE",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-09",
        "last_updated": "2016-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "RI",
            "license": "PS01032",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "RI",
            "license": "PS01032",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.