Individual
LORI WIESNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.W., L.I.C.S.W.
Contact information
Practice address
304 FRONT ST, LINCOLN, RI 02865-2425
(401) 725-9400
(401) 725-9424
Mailing address
5 CRESTWOOD LN, LINCOLN, RI 02865-3630
(401) 475-4199
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
ISW01263
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1064580
NHP OF RI
RI
01
—
30310-3
BLUE CROSS/BLUE SHIELD
RI
01
—
406304
BLUE CHIP
RI
01
—
62-32349
UNITED BEHAVIORAL HEALTH
RI
05
—
LW59545
—
RI
Enumeration date
09/16/2006
Last updated
07/08/2007
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