Healthcare Provider Details

I. General information

NPI: 1316260201
Provider Name (Legal Business Name): LISA ANN SPARLING LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA ANN BORDAGE

II. Dates (important events)

Enumeration Date: 03/05/2010
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 QUEEN STREET
WORCESTER MA
01610-2473
US

IV. Provider business mailing address

26 QUEEN STREET
WORCESTER MA
01610-2473
US

V. Phone/Fax

Practice location:
  • Phone: 508-860-7800
  • Fax:
Mailing address:
  • Phone: 85-860-7800
  • Fax: 800-518-6055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7761
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: