Provider Demographics
NPI:1033745179
Name:MCNAMARA, LISA MARIE (HIS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:MCNAMARA
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 MAIN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-3057
Mailing Address - Country:US
Mailing Address - Phone:978-632-6883
Mailing Address - Fax:978-410-5787
Practice Address - Street 1:354 MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-3057
Practice Address - Country:US
Practice Address - Phone:978-632-6883
Practice Address - Fax:978-410-5787
Is Sole Proprietor?:No
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA440237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist