MEDICARE: LISA WHOLEY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1568394468
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LISA WHOLEY LLC

Provider Business Mailing Address
First Line	:	74 EVERGREEN CT
Second Line	:
City	:	WAKEFIELD
State	:	RI
Zip	:	02879-1652
Country	:	US
Telephone Number	:	401-368-1828
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 CANAL ST STE 2
Second Line	:
City	:	WESTERLY
State	:	RI
Zip	:	02891-1579
Country	:	US
Telephone Number	:	401-237-0787
Fax Number	:

Authorized Official
Title or Position	:	OWNER-PSYCHOLOGIST
Name	:	DR. LISA J WHOLEY
Credential	:	PHD
Telephone Number	:	401-368-1828

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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Directions to “LISA WHOLEY LLC ” Practice Location

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