Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PS00787 | RI |
N | 103G00000X | Clinical Psychologist | PS00787 | RI |
N | 103TC0700X | Clinical Psychologist | PS00787 | RI |
NPI | 1386620466 |
---|---|
Provider Name | Dr. Henry R Lesieur |
First Address | Providence, RI 02903-4923 |
Second Address | Providence, RI 02903-4923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P72018 | (02) |