Healthcare Provider Details

I. General information

NPI: 1902067994
Provider Name (Legal Business Name): LISA A NOWINSKI MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 12/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MASSACHUSETTS GENERAL HOSPITAL 55 FRUIT STREET
BOSTON MA
02114
US

IV. Provider business mailing address

MASSACHUSETTS GENERAL HOSPITAL 55 FRUIT STREET
BOSTON MA
02114
US

V. Phone/Fax

Practice location:
  • Phone: 781-860-1700
  • Fax: 781-860-1766
Mailing address:
  • Phone: 781-860-1700
  • Fax: 781-860-1766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number9310
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: