Healthcare Provider Details

I. General information

NPI: 1992295521
Provider Name (Legal Business Name): LISA M LACHANCE HARTWICK LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 05/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE
BOSTON MA
02215-5400
US

IV. Provider business mailing address

98 HOWARD ST
MELROSE MA
02176-2004
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-3458
  • Fax: 617-667-8701
Mailing address:
  • Phone: 617-784-6877
  • Fax: 617-667-8701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1017478
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: