Healthcare Provider Details

I. General information

NPI: 1568394468
Provider Name (Legal Business Name): LISA WHOLEY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 07/12/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 CANAL ST STE 2
WESTERLY RI
02891-1579
US

IV. Provider business mailing address

21 CANAL ST STE 2
WESTERLY RI
02891-1579
US

V. Phone/Fax

Practice location:
  • Phone: 401-237-0787
  • Fax:
Mailing address:
  • Phone: 401-326-2887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. LISA J WHOLEY
Title or Position: OWNER-PSYCHOLOGIST
Credential: PHD
Phone: 401-326-2887