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General NPI Number Information
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NPI Number | 1699358267
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Entity Type | Individual
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Provider Name | MARISA LYCURGUS
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Gender | Female
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Dates
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Enumeration Date | 05/03/2021
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 10 PROSPECT ST STE 202
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City | NASHUA
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State | NH
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Zip | 03060-3922
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Country | US
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Telephone | 781-551-0999
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Fax | 781-551-3396
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Provider Business Mailing Address
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Address Line | 10 PROSPECT ST
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City | NASHUA
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State | NH
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Zip | 03060-3922
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Country | US
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Telephone | 603-886-7900
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 231105
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 115269
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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