Individual
LISA A PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC LCDP LCDCS MAC
Contact information
Practice address
110 ELMWOOD AVE, PROVIDENCE, RI 02907-2423
(401) 432-6029
(401) 300-5656
Mailing address
110 ELMWOOD AVE, PROVIDENCE, RI 02907-2423
(401) 432-6029
(401) 300-5656
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MHC00235
RI
103TA0400X
Addiction (Substance Use Disorder) Psychologist
LCDP00129
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
29290 8
BLUE CROSS
RI
01
—
412210
BLUE CHIP
RI
05
—
LJ55332
—
RI
Enumeration date
08/31/2006
Last updated
06/10/2025
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