Healthcare Provider Details

I. General information

NPI: 1780916841
Provider Name (Legal Business Name): LISA CAHILL-GREEN LIC. AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2010
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 WEST ST SUITE 5
MILLBURY MA
01527-2622
US

IV. Provider business mailing address

22 WEST ST SUITE 5
MILLBURY MA
01527-2622
US

V. Phone/Fax

Practice location:
  • Phone: 774-276-0568
  • Fax:
Mailing address:
  • Phone: 774-276-0568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number243052
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: