Healthcare Provider Details

I. General information

NPI: 1205953064
Provider Name (Legal Business Name): LISA KLEIN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 DERBY ST SUITE 2
HINGHAM MA
02043-4007
US

IV. Provider business mailing address

175 DERBY ST SUITE 2
HINGHAM MA
02043-4007
US

V. Phone/Fax

Practice location:
  • Phone: 781-749-9227
  • Fax: 781-740-0233
Mailing address:
  • Phone: 781-749-9227
  • Fax: 781-740-0233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number105615
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: