Lisandra Dju

Individual provider Active NPI Marriage & Family Therapist · Providence, RI

NPI 1487257523 · NPPES record last updated Nov 20, 2020

Key facts

NPI
1487257523
Entity type
Individual (NPI type 1)
Primary specialty
Marriage & Family Therapist 106H00000X
License
MFT00218 (RI)
Practice address
55 Hope St
Providence, RI 02906-2001
Phone
(401) 331-1350
NPI assigned
Nov 20, 2020
Sex
Female
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
MFT00218RIMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Archer Mental Wellness, LLC Marriage & Family Therapist Current
since Aug 28, 2021
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X MFT00218 RI Yes

Addresses

Primary practice location

55 Hope St
Providence, RI 02906-2001

Mailing address

63 Bristol Ave
Pawtucket, RI 02861-2117
Phone (401) 572-8052

Other providers in Providence, RI

All providers in Providence, RI · Marriage & Family Therapist in Rhode Island

Sources for this page

Verify at the official NPI Registry.