Provider Demographics
NPI:1619458395
Name:LOVETT, LISA (LICSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:LOVETT
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 1:21 REED ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-2413
Mailing Address - Country:US
Mailing Address - Phone:617-365-5232
Mailing Address - Fax:
Practice Address - Street 1:2352 MAIN ST STE 206
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-3849
Practice Address - Country:US
Practice Address - Phone:978-263-5400
Practice Address - Fax:978-266-1909
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1131261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical