Provider Demographics
NPI:1164604674
Name:MAUGHAM, LIZA (SOCIAL WORKER)
Entity Type:Individual
Prefix:MS
First Name:LIZA
Middle Name:
Last Name:MAUGHAM
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1269 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-3099
Mailing Address - Country:US
Mailing Address - Phone:978-287-7968
Mailing Address - Fax:
Practice Address - Street 1:1269 MAIN ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-3099
Practice Address - Country:US
Practice Address - Phone:978-287-7968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1109141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110914OtherPROFESSIONAL LICENSURE