Provider Demographics
NPI:1164870598
Name:CHISHOLM, LAUREN ZERANSKI (PHD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ZERANSKI
Last Name:CHISHOLM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 LIBBEY PKWY
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-3101
Mailing Address - Country:US
Mailing Address - Phone:781-551-0999
Mailing Address - Fax:781-551-3396
Practice Address - Street 1:169 LIBBEY PKWY
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-3101
Practice Address - Country:US
Practice Address - Phone:781-551-0999
Practice Address - Fax:781-551-3396
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10374103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist