Healthcare Provider Details

I. General information

NPI: 1942637970
Provider Name (Legal Business Name): LISA CARI RIEGEL PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA CARI VAZQUEZ PMHNP-BC

II. Dates (important events)

Enumeration Date: 10/04/2013
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 CLARK STREET
BRIDGEPORT CT
06606
US

IV. Provider business mailing address

618 CLARK STREET
BRIDGEPORT CT
06606
US

V. Phone/Fax

Practice location:
  • Phone: 203-790-4667
  • Fax:
Mailing address:
  • Phone: 203-790-4667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number12-005567
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: