Provider Demographics
NPI:1285938894
Name:KNIGHT, LISA CHRISTINE (LICSW)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:CHRISTINE
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 MENDON RD STE 21
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-3825
Mailing Address - Country:US
Mailing Address - Phone:401-263-4597
Mailing Address - Fax:
Practice Address - Street 1:2180 MENDON RD STE 21
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-3825
Practice Address - Country:US
Practice Address - Phone:401-263-4597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-23
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW01362104100000X
MA1227171041C0700X
RIISW024331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1285938894Medicaid
RI1285938894OtherBCBSRI
RI003438201OtherMEDICARE PTAN
RILK87491Medicaid