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General NPI Number Information
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NPI Number | 1649535261
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Entity Type | Individual
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Provider Name | LISA REIDSEMA LMHC, LPC, CCTP
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Gender | Female
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Dates
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Enumeration Date | 07/10/2012
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Last Update Date | 06/22/2018
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Provider Practice Location Address
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Address Line | 194 WATERMAN ST SUITE 1
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City | PROVIDENCE
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State | RI
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Zip | 02906
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Country | US
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Telephone | 401-484-0244
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Fax | 855-239-0365
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Provider Business Mailing Address
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Address Line | 194 WATERMAN ST SUITE 1
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City | PROVIDENCE
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State | RI
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Zip | 02906
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Country | US
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Telephone | 401-484-0244
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Fax | 855-239-0365
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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 | 101YM0800X
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Taxonomy Name | Mental Health
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License Number | MH 12785
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health
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License Number | LPC6959
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health
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License Number | LMHC10564
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health
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License Number | MHC00905
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License Number State | RI
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