Provider Demographics
NPI:1356679856
Name:FIORE, LISA R (LICSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:R
Last Name:FIORE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 DUDLEY ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-2401
Mailing Address - Country:US
Mailing Address - Phone:401-274-1100
Mailing Address - Fax:401-453-7597
Practice Address - Street 1:101 DUDLEY ST
Practice Address - Street 2:PHO OFFICE
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-2401
Practice Address - Country:US
Practice Address - Phone:401-274-1100
Practice Address - Fax:401-453-7597
Is Sole Proprietor?:No
Enumeration Date:2009-11-23
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW011901041C0700X
RIISW023181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical