Healthcare Provider Details

I. General information

NPI: 1518807973
Provider Name (Legal Business Name): LISA MARIE AVENELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2026
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 HIGHLAND AVE
SOMERVILLE MA
02143-1933
US

IV. Provider business mailing address

249 RIVER ST UNIT 330
MATTAPAN MA
02126-2780
US

V. Phone/Fax

Practice location:
  • Phone: 617-623-5277
  • Fax: 617-844-1354
Mailing address:
  • Phone: 617-623-5277
  • Fax: 617-844-1354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: