Provider Demographics
NPI:1588672810
Name:REID, ELISA D (MA, LCDP)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:D
Last Name:REID
Suffix:
Gender:F
Credentials:MA, LCDP
Other - Prefix:
Other - First Name:ELISA
Other - Middle Name:D
Other - Last Name:REID
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LCDP
Mailing Address - Street 1:900 RESERVOIR AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-4453
Mailing Address - Country:US
Mailing Address - Phone:401-632-4114
Mailing Address - Fax:401-632-4880
Practice Address - Street 1:900 RESERVOIR AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-4453
Practice Address - Country:US
Practice Address - Phone:401-632-4114
Practice Address - Fax:401-632-4880
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILCDP00292101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIER51361Medicaid
RI62-69633OtherUBH