Provider Demographics
NPI:1568470367
Name:YANKU, LISA G (LICSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:G
Last Name:YANKU
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 1:4014 CONNECTION POINT BLVD
Mailing Address - Street 2:STE C
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-0332
Mailing Address - Country:US
Mailing Address - Phone:401-738-4300
Mailing Address - Fax:
Practice Address - Street 1:50 HEALTH LN
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2711
Practice Address - Country:US
Practice Address - Phone:401-738-4300
Practice Address - Fax:401-738-8634
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0092431041C0700X
RIISW004981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RILY10977Medicaid
RI30118-1OtherBLUE CROSS
RI62-67493OtherUBH
RI408503OtherBLUE CHIP