=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194985754
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. MARK CHRISTOPHER LIONETTI
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2008
-----------------------------------------------------
Last Update Date | 06/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 37 BELMONT ST
-----------------------------------------------------
City | BROCKTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02301-5299
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-830-0000
-----------------------------------------------------
Fax | 508-588-5751
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 6043
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02362-6043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-980-2989
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------