Provider Demographics
NPI:1417946757
Name:LIVSHIN, LISA YETTA (EDD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:YETTA
Last Name:LIVSHIN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 MARGARET RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02461-1610
Mailing Address - Country:US
Mailing Address - Phone:617-244-2070
Mailing Address - Fax:617-244-2070
Practice Address - Street 1:69 MARGARET RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02461-1610
Practice Address - Country:US
Practice Address - Phone:617-244-2070
Practice Address - Fax:617-244-2070
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4819103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAWAW04628Medicare ID - Type Unspecified