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General NPI Number Information
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NPI Number | 1831546324
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Entity Type | Individual
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Provider Name | LISA BRAYTON I LSW
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Gender | Female
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Dates
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Enumeration Date | 05/16/2016
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Last Update Date | 05/16/2016
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Provider Practice Location Address
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Address Line | 27 WATER ST SUITE 109
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City | WAKEFIELD
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State | MA
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Zip | 01880-3032
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Country | US
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Telephone | 781-246-2003
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Fax | 781-245-6377
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Provider Business Mailing Address
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Address Line | 27 WATER ST SUITE 109
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City | WAKEFIELD
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State | MA
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Zip | 01880-3032
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Country | US
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Telephone | 781-246-2003
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Fax | 781-245-6377
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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 | 314077
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License Number State | MA
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