Lisa Broccoli Defusco, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

ISW02535. Issued in RI

Practice address

55 Hope St
Providence, RI 02906-2001

Phone

(401) 331-1350

Fax

(401) 277-3366

NPI assigned

Jul 17, 2012

Last updated

May 15, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in RI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Gateway Healthcare Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Pawtucket, RI
  • NPI 1821078932
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1342483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747267200000",
    "number": "1952656837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6688",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029406688",
            "telephone_number": "401-331-1350",
            "fax_number": "401-277-3366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 HOPE ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029062001",
            "telephone_number": "401-331-1350",
            "fax_number": "401-277-3366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEFUSCO",
        "first_name": "LISA",
        "middle_name": "BROCCOLI",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-17",
        "last_updated": "2025-05-15",
        "certification_date": "2025-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "RI",
            "license": "CSW01449",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "RI",
            "license": "ISW02535.",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph A Decesare, DPM
• Jaclyn Decoursey, PA-C
• Rosemary E Decroce, PSYD
• Deepak Saluja, DMD Inc. (DentPlus Dental Center)
• Paul C. Deffely, LMFT
• Amy Elizabeth Degaetano
• Aris Degaitas, PA
• Kelsey Lee Degouveia, MD
• Lynne Ann Deion, RN, BC, LCDP
• Neyda Dejesus

• Clinical Social Worker in Providence, RI
• Providers in Providence, RI by specialty
• Clinical Social Worker in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.