MEDICARE: LISA M. FEDOCE M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker
2	101Y00000X	Counselor

General Provider Information

NPI Number	:	1285756445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA M. FEDOCE M.S.

Provider Business Mailing Address
First Line	:	110 BOSTON STREET
Second Line	:	CHILDREN'S FRIEND AND FAMILY SERVICES, INC.
City	:	SALEM
State	:	MA
Zip	:	01970-1402
Country	:	US
Telephone Number	:	978-744-7903
Fax Number	:	978-740-9145

Provider Business Practice Location Address
First Line	:	110 BOSTON STREET
Second Line	:	CHILDREN'S FRIEND AND FAMILY SERVICES, INC.
City	:	SALEM
State	:	MA
Zip	:	01970-1402
Country	:	US
Telephone Number	:	978-744-7903
Fax Number	:	978-740-9145

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	05/19/2010

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