Healthcare Provider Details

I. General information

NPI: 1205730017
Provider Name (Legal Business Name): LENA LAX NP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 DAVIS SQ STE 311
SOMERVILLE MA
02144-2900
US

IV. Provider business mailing address

55 DAVIS SQ STE 311
SOMERVILLE MA
02144-2900
US

V. Phone/Fax

Practice location:
  • Phone: 617-334-5155
  • Fax:
Mailing address:
  • Phone: 617-334-5155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: LENA LAX
Title or Position: PROVIDER, OWNER
Credential: NP
Phone: 617-334-5155