Kelley Harrison Pistacchio, PH.D

Primary specialty

Group Psychotherapy PsychologistTaxonomy code 103TP2701X

License

PS00680 Issued in RI

Practice address

610 Manton Ave
Providence, RI 02909-5633

Phone

(401) 274-6310

Fax

(401) 421-1977

NPI assigned

Mar 5, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 6

Addresses

Other identifiers 4

Other names 1

• Dr. Kelley Harrison Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1780713735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 JANE ST",
            "city": "NORTH PROVIDENCE",
            "state": "RI",
            "postal_code": "029044957",
            "telephone_number": "401-274-6310",
            "fax_number": "401-421-1977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 MANTON AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029095633",
            "telephone_number": "401-274-6310",
            "fax_number": "401-421-1977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PISTACCHIO",
        "first_name": "KELLEY",
        "middle_name": "HARRISON",
        "name_prefix": "Dr.",
        "credential": "PH.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-05",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "RI",
            "license": "PS00680",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "RI",
            "license": "PS00680",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "RI",
            "license": "PS00680",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "RI",
            "license": "PS00680",
            "primary": false
        },
        {
            "code": "103TM1800X",
            "taxonomy_group": "",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": "RI",
            "license": "PS00680",
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "RI",
            "license": "PS00680",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHIP",
            "identifier": "410468",
            "state": "RI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "KH29823",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "30189-1",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED BEHAVIORAL HEALTH",
            "identifier": "61-00006",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLEY",
            "last_name": "HARRISON",
            "prefix": "DR.",
            "credential": "PH.D",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Group Psychotherapy Psychologist in Providence, RI
• Providers in Providence, RI by specialty
• Group Psychotherapy Psychologist in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.