=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467782557
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LISA MANZI LENTINO PHD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2010
-----------------------------------------------------
Last Update Date | 01/12/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 416 BOSTON POST RD
-----------------------------------------------------
City | SUDBURY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01776-3016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-443-5611
-----------------------------------------------------
Fax | 978-443-4769
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 416 BOSTON POST RD
-----------------------------------------------------
City | SUDBURY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01776-3016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-443-5611
-----------------------------------------------------
Fax | 978-443-4769
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PSYCHOLOGIST
-----------------------------------------------------
Name | LISA MANZI LENTINO
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 978-443-5611
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 7893
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------