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General NPI Number Information
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NPI Number | 1487900411
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Entity Type | Individual
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Provider Name | LISA WALDMAN M.S.
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Gender | Female
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Dates
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Enumeration Date | 07/27/2012
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Last Update Date | 06/25/2015
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Provider Practice Location Address
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Address Line | 1950 TOWER HILL RD
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City | NORTH KINGSTOWN
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State | RI
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Zip | 02852-6639
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Country | US
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Telephone | 401-235-7000
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Fax | 401-235-7000
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Provider Business Mailing Address
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Address Line | 800 CLINTON ST
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City | WOONSOCKET
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State | RI
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Zip | 02895-3245
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Country | US
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Telephone | 401-235-7000
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Fax | 401-767-4516
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CDP00110
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 2438
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License Number State | MA
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