Healthcare Provider Details

I. General information

NPI: 1003552167
Provider Name (Legal Business Name): LISA C LAWLOR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 CENTRAL ST
ACTON MA
01720-4790
US

IV. Provider business mailing address

80 APPLE BLOSSOM WAY
STOW MA
01775-1388
US

V. Phone/Fax

Practice location:
  • Phone: 978-254-0297
  • Fax:
Mailing address:
  • Phone: 978-254-0297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number226624
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: