Provider Demographics
NPI:1215158894
Name:CARVALHO, LISA S (MSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:S
Last Name:CARVALHO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 DAGGETT AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02861-2242
Mailing Address - Country:US
Mailing Address - Phone:401-497-5261
Mailing Address - Fax:
Practice Address - Street 1:400 DAGGETT AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02861-2242
Practice Address - Country:US
Practice Address - Phone:401-497-5261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2160831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM18708OtherBLUE CROSS
MA1312677Medicaid
MA685661OtherTUFTS
MAM20807Medicare ID - Type Unspecified