Healthcare Provider Details

I. General information

NPI: 1427276740
Provider Name (Legal Business Name): ANDREA REIS LCDP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 TOLL GATE RD
WARWICK RI
02886-4416
US

IV. Provider business mailing address

300 TOLL GATE RD
WARWICK RI
02886-4416
US

V. Phone/Fax

Practice location:
  • Phone: 401-785-0050
  • Fax:
Mailing address:
  • Phone: 401-785-0040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDP00395
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: