Healthcare Provider Details

I. General information

NPI: 1437081361
Provider Name (Legal Business Name): DR. LARA ZIDOON NASSER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 LAKE AVE N
WORCESTER MA
01655-0002
US

IV. Provider business mailing address

84 WOODLAND RD
MILTON MA
02186-3643
US

V. Phone/Fax

Practice location:
  • Phone: 774-441-7773
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License NumberPH241132
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: