Healthcare Provider Details

I. General information

NPI: 1891817474
Provider Name (Legal Business Name): LIZETTE M MARQUES BACEIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1563 N MAIN ST SUITE 208
FALL RIVER MA
02720
US

IV. Provider business mailing address

1563 NORTH MAIN STREET
FALL RIVER MA
02720
US

V. Phone/Fax

Practice location:
  • Phone: 508-324-1060
  • Fax:
Mailing address:
  • Phone: 508-324-1060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number2370-SP-SA
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: