Individual
LISA ROBERTS IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
55 JOHN A CUMMINGS WAY, WOONSOCKET, RI 02895-3247
(401) 235-7000
Mailing address
637 S MAIN ST, WOONSOCKET, RI 02895-5758
(401) 769-3186
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
PC396
RI
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDP00537
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LR56123
—
RI
Enumeration date
10/05/2006
Last updated
10/30/2012
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