Provider Demographics
NPI:1417326398
Name:BRESLIN, LISA K (LCMT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:BRESLIN
Suffix:
Gender:F
Credentials:LCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:27 CONGRESS ST. #203
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-0247
Mailing Address - Country:US
Mailing Address - Phone:617-833-3781
Mailing Address - Fax:
Practice Address - Street 1:27 CONGRESS ST STE 203
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-5576
Practice Address - Country:US
Practice Address - Phone:617-833-3781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-21
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5085174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5085-MTOtherCOMM. OF MASS. DIV. OF PROF. LICENSURE