Provider Demographics
NPI:1780082149
Name:VERDEROSA, LORETTA (LCDP)
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:
Last Name:VERDEROSA
Suffix:
Gender:F
Credentials:LCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 THIRD BEACH RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-5739
Mailing Address - Country:US
Mailing Address - Phone:401-632-2027
Mailing Address - Fax:401-310-0502
Practice Address - Street 1:426 THIRD BEACH RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-5739
Practice Address - Country:US
Practice Address - Phone:401-632-2027
Practice Address - Fax:401-310-0502
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICDP00082101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)