Healthcare Provider Details

I. General information

NPI: 1588810584
Provider Name (Legal Business Name): OLGA LISYSYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2008
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1595 LAKEVIEW AVE
DRACUT MA
01826-3396
US

IV. Provider business mailing address

15 POND VIEW DR
ACTON MA
01720-4319
US

V. Phone/Fax

Practice location:
  • Phone: 978-455-2628
  • Fax:
Mailing address:
  • Phone: 978-761-8418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: