Healthcare Provider Details

I. General information

NPI: 1982159026
Provider Name (Legal Business Name): LAUREN MACISAAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2016
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 CHELMSFORD ST NO. 13
CHELMSFORD MA
01824-2305
US

IV. Provider business mailing address

142 PLEASANT VALLEY ST APT 140302
METHUEN MA
01844-7218
US

V. Phone/Fax

Practice location:
  • Phone: 197-852-2447
  • Fax:
Mailing address:
  • Phone: 978-852-2447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: