Provider Demographics
NPI:1568624625
Name:MASSARO, LISA DIANE (MFT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DIANE
Last Name:MASSARO
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 COLLEGE POND RD # Q
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-3105
Mailing Address - Country:US
Mailing Address - Phone:626-399-4290
Mailing Address - Fax:
Practice Address - Street 1:125 COLLEGE POND RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-3105
Practice Address - Country:US
Practice Address - Phone:626-399-4290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2023-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1925106H00000X
CA43286106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist