Peterson, Lisa A

Peterson, Lisa A is an individual health care provider with primary practice located at 110 Elmwood Ave , Providence RI 02907-2423. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Mental Health. Behavioral Health & Social Service Providers / Mental Health is her primary health care specialty. Peterson, Lisa A can be contacted via phone (401) 432-6029.

Contact Information

Primary practice address
110 Elmwood Ave Providence RI 02907-2423
Phone: (401) 432-6029
Fax: (401) 300-5656
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 103TA0400X LCDP00129 Rhode Island
Behavioral Health & Social Service Providers / Mental Health 101YM0800X MHC00235 Rhode Island

Profile Details

NPI number 1962514869
LBN Legal business name Peterson, Lisa A
Credentials LMHC LCDP LCDCS MAC
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 31st, 2006
Last updated Jun 26th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1962514869 NPPES
Rhode Island Other 412210 BLUE CHIP
Rhode Island Other 29290 8 BLUE CHIP
Rhode Island MEDICAID LJ55332 BLUE CHIP

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