Provider Demographics
NPI:1790087245
Name:KEYES, LISA MARIE (MAC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIE
Last Name:KEYES
Suffix:
Gender:F
Credentials:MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 STRATHMORE RD
Mailing Address - Street 2:APT. 4
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-7118
Mailing Address - Country:US
Mailing Address - Phone:413-219-8253
Mailing Address - Fax:
Practice Address - Street 1:109 STRATHMORE RD
Practice Address - Street 2:APT. 4
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-7118
Practice Address - Country:US
Practice Address - Phone:413-219-8253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01738171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist