Provider Demographics
NPI:1114214012
Name:DAPONTE, LISA J (MSW, LICSW)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:J
Last Name:DAPONTE
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02907-1524
Mailing Address - Country:US
Mailing Address - Phone:401-274-8811
Mailing Address - Fax:401-274-8877
Practice Address - Street 1:270 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-1524
Practice Address - Country:US
Practice Address - Phone:401-274-8811
Practice Address - Fax:401-274-8877
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1176851041C0700X
RIISW023991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical