Healthcare Provider Details

I. General information

NPI: 1477903508
Provider Name (Legal Business Name): LISA CARLSON-HILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 06/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LAHEY HOSPITAL & MEDICAL CTR 41 MALL RD.
BURLINGTON MA
01805-0001
US

IV. Provider business mailing address

175 LOWELL ST
ARLINGTON MA
02474-3923
US

V. Phone/Fax

Practice location:
  • Phone: 781-744-8013
  • Fax: 781-744-5235
Mailing address:
  • Phone: 781-648-5614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number113558
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: