Provider Demographics
NPI:1558822296
Name:ANDERSON, LISA M (PMHNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MARKET ST STE 14
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777-3998
Mailing Address - Country:US
Mailing Address - Phone:401-447-2272
Mailing Address - Fax:
Practice Address - Street 1:25 MARKET ST STE 14
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777-3998
Practice Address - Country:US
Practice Address - Phone:401-447-2272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN224905363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health