MEDICARE: LISA SOLOMON

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1891000675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA SOLOMON

Provider Business Mailing Address
First Line	:	PO BOX 826
Second Line	:
City	:	GREAT BARRINGTON
State	:	MA
Zip	:	01230-0826
Country	:	US
Telephone Number	:	413-644-6473
Fax Number	:

Provider Business Practice Location Address
First Line	:	32 SILVER ST
Second Line	:
City	:	GREAT BARRINGTON
State	:	MA
Zip	:	01230-1925
Country	:	US
Telephone Number	:	413-644-6473
Fax Number	:

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

Provider Enumeration Date	:	08/17/2010
Last Update Date	:	04/26/2022

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Directions to “ LISA SOLOMON ” Practice Location

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