Healthcare Provider Details

I. General information

NPI: 1750291530
Provider Name (Legal Business Name): LISA PEZZELLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 COMMERCE WAY STE 1500
WOBURN MA
01801-1077
US

IV. Provider business mailing address

18 COMMERCE WAY STE 1500
WOBURN MA
01801-1077
US

V. Phone/Fax

Practice location:
  • Phone: 781-460-9756
  • Fax: 260-547-7935
Mailing address:
  • Phone: 781-460-9756
  • Fax: 260-548-7935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1054242
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: