MEDICARE: DR. AMY CAROL LISSER M.D.

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	2084P0800X	Psychiatry Physician	60303	MA

General Provider Information

NPI Number	:	1417927062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY CAROL LISSER M.D.

Provider Business Mailing Address
First Line	:	170 MORTON ST
Second Line	:	LEMUAL SHATTUCK HOSPITAL
City	:	JAMAICA PLAIN
State	:	MA
Zip	:	02130-3735
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	170 MORTON ST
Second Line	:	LEMUEL SHATTUCK HOSPITAL
City	:	JAMAICA PLAIN
State	:	MA
Zip	:	02130-3735
Country	:	US
Telephone Number	:	617-971-3177
Fax Number	:	617-522-7888

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

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	07/08/2007

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