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NPI Code Detail

MEDICARE: LISA PREMO

MEDICARE: LISA PREMO
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 Counselor

General Provider Information

NPI Number : 1598300568
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA PREMO
Provider Business Mailing Address
First Line : 11 SYCAMORE ST
Second Line :
City : WORCESTER
State : MA
Zip : 01608-2213
Country : US
Telephone Number : 508-798-1900
Fax Number : 508-798-1914
Provider Business Practice Location Address
First Line : 11 SYCAMORE ST
Second Line :
City : WORCESTER
State : MA
Zip : 01608-2213
Country : US
Telephone Number : 508-798-1900
Fax Number : 508-798-1914
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2019
Last Update Date : 05/18/2026

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Directions to “ LISA PREMO ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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