DR. KELLEY HARRISON PISTACCHIO PH.D
NPI 1780713735
Psychologist - Group Psychotherapy in Providence, RI

Q: What is Kelley Pistacchio's NPI number?

The NPI number for Kelley Pistacchio is 1780713735. It was assigned to this individual provider in the NPPES registry on March 5, 2007. The provider is also known as Dr. Kelley Harrison Ph.D.

Q: What is Kelley Pistacchio's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Group Psychotherapy, with taxonomy code 103TP2701X.

Q: When was this NPI record last updated?

The NPPES record for Kelley Pistacchio was last updated on September 11, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since March 05, 2007PECOS Enrolled

610 MANTON AVE, PROVIDENCE, RI 02909(401) 274-6310(401) 421-1977 Get Directions Write a Review

NPPES record last updated: September 11, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

On this page

About Dr. Kelley Harrison Pistacchio Ph.d NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. KELLEY HARRISON PISTACCHIO PH.D (NPI 1780713735) is an individual group psychotherapy provider in Providence, Rhode Island, licensed in Rhode Island (PS00680) and active in the NPI registry since March 2007. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1780713735

Entity TypeIndividualFemale

Primary Taxonomy103TP2701X

Provider Legal NameDR. KELLEY HARRISON PISTACCHIOCredential: PH.D

Location Address610 MANTON AVEProvidence, RI 02909-5633

Mailing Address122 Jane StNorth Providence, RI 02904-4957 · (401) 274-6310 · Fax (401) 421-1977

Phone(401) 274-6310

Fax(401) 421-1977

Sole ProprietorNo

Enumeration DateMarch 5, 2007

Last NPPES UpdateSeptember 11, 2025

✔ NPI 1780713735 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 6

★ Primary SpecialtyPsychologist · Group PsychotherapyBehavioral Health & Social Service Providers

Taxonomy Code103TP2701X

License✔ Licensed in RI · PS00680

Definition

A psychologist who specializes in group psychology and group psychotherapy that is an evidenced-based specialty that prepares group leaders to identify and capitalize on developmental and healing possibilities embedded in the interpersonal/intrapersonal functioning of individual group members as well as collectively for the group. Emphasis is placed on the use of group dynamics to assist and treat individual group members. The specialty is applicable to all age groups, children, adolescents, adults and older adults, for a wide variety of conditions and concerns, and in numerous and diverse settings.

Also ListedPsychologistTaxonomy 103T00000X · License PS00680 (RI)

Also ListedPsychologist · Cognitive & BehavioralTaxonomy 103TB0200X · License PS00680 (RI)

Also ListedPsychologist · ClinicalTaxonomy 103TC0700X · License PS00680 (RI)

Also ListedPsychologist · Clinical Child & AdolescentTaxonomy 103TC2200X · License PS00680 (RI)

Also ListedPsychologist · Intellectual and Developmental DisabilitiesTaxonomy 103TM1800X · License PS00680 (RI)

Other Names 1

Former Name (1)Dr. Kelley Harrison Ph.d

Other Identifiers 4

Other410468RI · Blue Chip

MedicaidKH29823RI

Other30189-1RI · Blue Cross

Other61-00006RI · United Behavioral Health

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Kelley Harrison Pistacchio Ph.d is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

THE COVE CENTER,INC

Community/Behavioral Health

610 MANTON AVE
PROVIDENCE, RI 02909

Providence County (401) 274-6310

MRS. MELISSA LYNN COE LICSW

Social Worker (Clinical)

610 MANTON AVE, 3RD FLOOR
PROVIDENCE, RI 02909

Providence County (401) 274-6310

MRS. KIMBERLY A BORLAND M.A., BCBA

Behavior Analyst

610 MANTON AVE, SUITE 311
PROVIDENCE, RI 02909

Providence County (401) 274-6310

MR. W. BRUCE RUBY II M.S., BCBA

Behavior Analyst

610 MANTON AVE
PROVIDENCE, RI 02909

Providence County (401) 274-6310

MS. NANCY MABRY STACHIW BCBA

Behavior Analyst

610 MANTON AVE
PROVIDENCE, RI 02909

Providence County (401) 274-6310

MRS. JUDITH LISA DUQUETTE M.A., BCBA

Behavior Analyst

610 MANTON AVE
PROVIDENCE, RI 02909

Providence County (401) 274-6310

MRS. JESSICA LYNNE WAUGH M. ED, BCBA

Behavior Analyst

610 MANTON AVE
PROVIDENCE, RI 02909

Providence County (401) 243-7213

MRS. LAURA ANN BEAUDRY LICSW

Social Worker (Clinical)

610 MANTON AVE
PROVIDENCE, RI 02909

Providence County (401) 274-6310

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelley Pistacchio's NPI number?

The NPI number for Kelley Pistacchio is 1780713735. It was assigned to this individual provider in the NPPES registry on March 5, 2007. The provider is also known as Dr. Kelley Harrison Ph.D.

Where is Kelley Pistacchio located?

Kelley Pistacchio practices at 610 Manton Ave, Providence, RI 02909. The listed phone number is (401) 274-6310.

What is Kelley Pistacchio's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Group Psychotherapy, with taxonomy code 103TP2701X.

Is Kelley Pistacchio enrolled in Medicare?

Yes. Kelley Pistacchio is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Kelley Pistacchio was last updated on September 11, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.