Healthcare Provider Details

I. General information

NPI: 1922169937
Provider Name (Legal Business Name): LISA F. ERRICO LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 HEIDI RD
SOUTH EASTON MA
02375-1231
US

IV. Provider business mailing address

10 HEIDI RD
SOUTH EASTON MA
02375-1231
US

V. Phone/Fax

Practice location:
  • Phone: 508-238-8837
  • Fax:
Mailing address:
  • Phone: 508-238-8837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number106359
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: