Healthcare Provider Details

I. General information

NPI: 1285560219
Provider Name (Legal Business Name): LESLIE LISI CADC LCDP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 FOUNTAIN AVE
CRANSTON RI
02920-7100
US

IV. Provider business mailing address

152 FOUNTAIN AVE
CRANSTON RI
02920-7100
US

V. Phone/Fax

Practice location:
  • Phone: 401-649-3067
  • Fax:
Mailing address:
  • Phone: 401-649-3067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDP00990
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: