Provider Demographics
NPI:1417451675
Name:VECCHIOLI, LISA A
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:VECCHIOLI
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 1:63 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-2219
Mailing Address - Country:US
Mailing Address - Phone:508-222-7422
Mailing Address - Fax:508-222-4288
Practice Address - Street 1:63 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-2219
Practice Address - Country:US
Practice Address - Phone:508-222-7422
Practice Address - Fax:508-222-4288
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator