Provider Demographics
NPI:1760032734
Name:DISAIA, DENISE J (LDCS)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:J
Last Name:DISAIA
Suffix:
Gender:F
Credentials:LDCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 NARRAGANSETT AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02907-3367
Mailing Address - Country:US
Mailing Address - Phone:401-941-4488
Mailing Address - Fax:401-941-9797
Practice Address - Street 1:160 NARRAGANSETT AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-3367
Practice Address - Country:US
Practice Address - Phone:401-491-4488
Practice Address - Fax:401-941-9797
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICDP00403101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)