Healthcare Provider Details

I. General information

NPI: 1578744850
Provider Name (Legal Business Name): MRS. LISA MARIE DEERY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 MAIN ST
FITCHBURG MA
01420-4331
US

IV. Provider business mailing address

PO BOX 89
WINCHENDON MA
01475-0089
US

V. Phone/Fax

Practice location:
  • Phone: 978-665-0025
  • Fax:
Mailing address:
  • Phone: 978-340-6240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: