Individual
MRS. LISA BROCCOLI DEFUSCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
55 HOPE ST, PROVIDENCE, RI 02906-2001
(401) 331-1350
(401) 277-3366
Mailing address
PO BOX 6688, PROVIDENCE, RI 02940-6688
(401) 331-1350
(401) 277-3366
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
CSW01449
RI
1041C0700X
Clinical Social Worker
Primary
ISW02535.
RI
Other
Enumeration date
07/17/2012
Last updated
05/15/2025
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