Provider Demographics
NPI:1598789307
Name:FRIEDLANDER, LISA MARGO (LICSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARGO
Last Name:FRIEDLANDER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SHEEP RD
Mailing Address - Street 2:
Mailing Address - City:LEE
Mailing Address - State:NH
Mailing Address - Zip Code:03824-6622
Mailing Address - Country:US
Mailing Address - Phone:603-969-9524
Mailing Address - Fax:509-267-0238
Practice Address - Street 1:1501 MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-4725
Practice Address - Country:US
Practice Address - Phone:978-858-0013
Practice Address - Fax:509-267-0238
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA107913101YM0800X
NH1030101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP 20932Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID
MA524369Medicare UPIN