Provider Demographics
NPI:1811226426
Name:WATRAS WRIGHT, LISA A (PMHNP-BC, MSN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:WATRAS WRIGHT
Suffix:
Gender:F
Credentials:PMHNP-BC, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 MEDFORD ST OFC 3
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-3124
Mailing Address - Country:US
Mailing Address - Phone:339-707-0460
Mailing Address - Fax:
Practice Address - Street 1:58 MEDFORD ST OFC 3
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-3124
Practice Address - Country:US
Practice Address - Phone:339-707-0460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT084752163W00000X
MARN2260842163WP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health