Active NPI
Lucille Waagen, PH.D., LP
- Counseling Psychologist
- Providence, RI
National Provider Identifier
1164233003
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- 655
- Practice address
- 111 Wayland Ave
Providence, RI 02906-4371 - Phone
- (401) 330-5882
- NPI assigned
- Jan 20, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | 655 | ND | Primary |
Addresses
Primary practice location
111 Wayland Ave
Providence, RI 02906-4371
Mailing address
630 Smithfield Rd Apt 708
North Providence, RI 02904-2930
Phone (406) 478-3190
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 655 | ND | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1737331200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1784678400000",
"number": "1164233003",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "630 SMITHFIELD RD APT 708",
"city": "NORTH PROVIDENCE",
"state": "RI",
"postal_code": "029042930",
"telephone_number": "406-478-3190"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 WAYLAND AVE",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029064371",
"telephone_number": "401-330-5882"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAAGEN",
"first_name": "LUCILLE",
"name_prefix": "Dr.",
"credential": "PH.D., LP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-01-20",
"last_updated": "2026-07-22",
"certification_date": "2026-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "ND",
"license": "655",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Providence, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.