Provider Demographics
NPI:1790926152
Name:LAGASSE, AMY LINN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:LINN
Last Name:LAGASSE
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 1:322 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02889-5438
Mailing Address - Country:US
Mailing Address - Phone:401-633-4079
Mailing Address - Fax:
Practice Address - Street 1:2 OLD COUNTY RD
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:RI
Practice Address - Zip Code:02806-1600
Practice Address - Country:US
Practice Address - Phone:401-246-1195
Practice Address - Fax:401-246-1985
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW021371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical