Provider Demographics
NPI:1326037490
Name:BLAZEJEWSKI, LISA M (MS,CGC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:BLAZEJEWSKI
Suffix:
Gender:F
Credentials:MS,CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 TREETOP PARK
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-1149
Mailing Address - Country:US
Mailing Address - Phone:508-366-8003
Mailing Address - Fax:
Practice Address - Street 1:200 FOREST ST
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3023
Practice Address - Country:US
Practice Address - Phone:774-843-3568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS