Provider Demographics
NPI:1689926479
Name:LUSSIER LIONAS, AMANDA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:LUSSIER LIONAS
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 1:69 FRANKLIN STREET
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701
Mailing Address - Country:US
Mailing Address - Phone:508-875-5801
Mailing Address - Fax:508-872-8934
Practice Address - Street 1:68 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-6671
Practice Address - Country:US
Practice Address - Phone:508-875-5801
Practice Address - Fax:508-872-8934
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA22220002001OtherBLUE CROSS BLUE SHEILD
MA1306421Medicaid
MA1308785Medicaid
MAM18684OtherBLUE CROSS BLUE SHEILD
MAM18684OtherBLUE CROSS BLUE SHEILD