Provider Demographics
NPI:1568942175
Name:PIEMONT, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:PIEMONT
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 1:771 SURRINER RD
Mailing Address - Street 2:
Mailing Address - City:BECKET
Mailing Address - State:MA
Mailing Address - Zip Code:01223-3592
Mailing Address - Country:US
Mailing Address - Phone:908-403-5268
Mailing Address - Fax:
Practice Address - Street 1:771 SURRINER RD
Practice Address - Street 2:
Practice Address - City:BECKET
Practice Address - State:MA
Practice Address - Zip Code:01223-3592
Practice Address - Country:US
Practice Address - Phone:908-403-5268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1187881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical