Provider Demographics
NPI:1487900411
Name:WALDMAN, LISA (MS)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:WALDMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-3245
Mailing Address - Country:US
Mailing Address - Phone:401-235-7000
Mailing Address - Fax:401-767-4516
Practice Address - Street 1:1950 TOWER HILL RD
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-6639
Practice Address - Country:US
Practice Address - Phone:401-235-7000
Practice Address - Fax:401-235-7000
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICDP00110101YA0400X
MA2438101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)