Provider Demographics
NPI:1427399500
Name:DAVIDSON, LISA-ANNE
Entity Type:Individual
Prefix:
First Name:LISA-ANNE
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1 DAVIS SQ
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2904
Mailing Address - Country:US
Mailing Address - Phone:617-623-6111
Mailing Address - Fax:617-776-7165
Practice Address - Street 1:1 DAVIS SQ
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2904
Practice Address - Country:US
Practice Address - Phone:617-623-6111
Practice Address - Fax:617-776-7165
Is Sole Proprietor?:No
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator