MEDICARE: DR. LISA YETTA LIVSHIN ED.D

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
1	103TC1900X	Counseling Psychologist	4819	MA

General Provider Information

NPI Number	:	1417946757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA YETTA LIVSHIN ED.D

Provider Business Mailing Address
First Line	:	69 MARGARET RD
Second Line	:
City	:	NEWTON
State	:	MA
Zip	:	02461-1610
Country	:	US
Telephone Number	:	617-244-2070
Fax Number	:	617-244-2070

Provider Business Practice Location Address
First Line	:	69 MARGARET RD
Second Line	:
City	:	NEWTON
State	:	MA
Zip	:	02461-1610
Country	:	US
Telephone Number	:	617-244-2070
Fax Number	:	617-244-2070

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	07/08/2007

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