Provider Demographics
NPI:1922338045
Name:LISS, LISA J (NP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:LISS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:63 FOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-6279
Mailing Address - Country:US
Mailing Address - Phone:508-872-4813
Mailing Address - Fax:508-626-0454
Practice Address - Street 1:814 BROAD ST
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-2031
Practice Address - Country:US
Practice Address - Phone:781-337-0550
Practice Address - Fax:781-337-0553
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA280505363LP0808X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health