Healthcare Provider Details

I. General information

NPI: 1124982509
Provider Name (Legal Business Name): LOIS M OBENG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 GRANITE AVE STE 260
MILTON MA
02186-4381
US

IV. Provider business mailing address

49 GRAMMONT RD
WORCESTER MA
01607-1113
US

V. Phone/Fax

Practice location:
  • Phone: 617-369-7136
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: