Provider Demographics
NPI:1265504906
Name:STAPLETON, LISA DAYNA
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:DAYNA
Last Name:STAPLETON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 BUCKINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186
Mailing Address - Country:US
Mailing Address - Phone:617-698-2252
Mailing Address - Fax:617-696-6963
Practice Address - Street 1:71 ADAMS ST
Practice Address - Street 2:SUITE 3
Practice Address - City:MILTON VILLAGE
Practice Address - State:MA
Practice Address - Zip Code:02187
Practice Address - Country:US
Practice Address - Phone:617-698-2252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10194901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
STP22558Medicare ID - Type Unspecified