Lee M Bradshaw, LCDP
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Providence, RI
NPI 1528072279 · NPPES record last updated Mar 27, 2009
Key facts
- NPI
- 1528072279
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- LCDP00093 (RI)
- Practice address
- 530 N Main St
Providence, RI 02904-5762 - Phone
- (401) 274-2500
- NPI assigned
- Jul 28, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCDP00093 | RI | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Providence Center Inc | Addiction (Substance Use Disorder) | Past | Accepting new patients |
| The Providence Center | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | LCDP00093 | RI | Yes |
Addresses
Primary practice location
530 N Main St
Providence, RI 02904-5762
Mailing address
528 N Main St
Providence, RI 02904-5757
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104847946 | Other | RI | THE PROVIDENCE CENTER NPI |
| 23770-3 | Other | RI | BLUE CROSS |
| 62-55385 | Other | RI | UNITED BEHAVIORAL HEALTH |
| 410282 | Other | RI | BLUE CHIP |
| LB48952 | Medicaid | RI |
Other providers in Providence, RI
- Diana L Bradford
- Nicholas Bradford
- Matthew Bradley
- Amanda Bradshaw
- Frances Veronica Bradshaw
- Edward P Brady
- Kayla Nicole Brady
- Lauren Brady
- Mark Brady
- Stacy Brady
All providers in Providence, RI · Addiction (Substance Use Disorder) Counselor in Rhode Island
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 27, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.