Healthcare Provider Details

I. General information

NPI: 1841783768
Provider Name (Legal Business Name): LISA ARIELLE TAYLOR PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 WORCESTER ST STE 3
SPRINGFIELD MA
01151-1056
US

IV. Provider business mailing address

11 HICKORY RD
SUDBURY MA
01776-2909
US

V. Phone/Fax

Practice location:
  • Phone: 413-543-6820
  • Fax:
Mailing address:
  • Phone: 561-271-6526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number10835
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: