Provider Demographics
NPI:1992859953
Name:LASOSKI, ANNE MARIE (PSYD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:LASOSKI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 POND AVE
Mailing Address - Street 2:SUITE # 1121
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7163
Mailing Address - Country:US
Mailing Address - Phone:617-735-1822
Mailing Address - Fax:781-348-2132
Practice Address - Street 1:250 POND ST
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-5351
Practice Address - Country:US
Practice Address - Phone:781-348-2260
Practice Address - Fax:781-348-2132
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7005103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA012265OtherPACIFICARE BEHAVIORAL HEA
MA0500801Medicaid
MA007005OtherTUFTS
MAW05938OtherBLUE CROSS
MA0500801Medicaid