MEDICARE: LISET MARILEISI GONZALEZ FAMILIA

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	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1447136593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISET MARILEISI GONZALEZ FAMILIA

Provider Business Mailing Address
First Line	:	227 PROSPECT ST APT 1
Second Line	:
City	:	LAWRENCE
State	:	MA
Zip	:	01841-2831
Country	:	US
Telephone Number	:	646-919-3408
Fax Number	:

Provider Business Practice Location Address
First Line	:	227 PROSPECT ST # 1
Second Line	:
City	:	LAWRENCE
State	:	MA
Zip	:	01841-2831
Country	:	US
Telephone Number	:	646-919-3408
Fax Number	:

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

Provider Enumeration Date	:	08/13/2025
Last Update Date	:	05/08/2026

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Directions to “ LISET MARILEISI GONZALEZ FAMILIA ” Practice Location

Language	Start Address	Practice Location

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