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NPI Code Detail

MEDICARE: MS. LISA JEAN ANTONIO LMHC

MEDICARE: MS. LISA JEAN ANTONIO LMHC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor10001407MA

General Provider Information

NPI Number : 1023175106
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LISA JEAN ANTONIO LMHC
Provider Business Mailing Address
First Line : 17 BEACH ST
Second Line :
City : WESTBOROUGH
State : MA
Zip : 01581-1601
Country : US
Telephone Number : 508-769-0571
Fax Number :
Provider Business Practice Location Address
First Line : 176 WEST ST
Second Line :
City : MILFORD
State : MA
Zip : 01757-2236
Country : US
Telephone Number : 508-634-3420
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2007
Last Update Date : 11/25/2023

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