Healthcare Provider Details

I. General information

NPI: 1487992509
Provider Name (Legal Business Name): LISA JAYNE PERNA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2013
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 W BOYLSTON ST STE 225
WEST BOYLSTON MA
01583-2373
US

IV. Provider business mailing address

443 OAK ST
SHREWSBURY MA
01545-4414
US

V. Phone/Fax

Practice location:
  • Phone: 774-261-8011
  • Fax: 857-557-6472
Mailing address:
  • Phone: 774-275-8791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number23187
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13520
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: