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NPI Code Detail

MEDICARE: LISA M. FEDOCE M.S.

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
11041C0700XClinical Social Worker
2101Y00000XCounselor

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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