Provider Demographics
NPI:1285018077
Name:LUSSIER, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LUSSIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-3245
Mailing Address - Country:US
Mailing Address - Phone:401-235-7000
Mailing Address - Fax:401-767-4516
Practice Address - Street 1:80 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4206
Practice Address - Country:US
Practice Address - Phone:401-235-7433
Practice Address - Fax:401-722-0269
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICDP00614101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)