Provider Demographics
NPI:1013255199
Name:BELLO, LISA R (LICSW, LADC-I, CEAP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:R
Last Name:BELLO
Suffix:
Gender:F
Credentials:LICSW, LADC-I, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 920271
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-0003
Mailing Address - Country:US
Mailing Address - Phone:617-680-7669
Mailing Address - Fax:
Practice Address - Street 1:1150 GREAT PLAIN AVE
Practice Address - Street 2:SUITE 920271
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492
Practice Address - Country:US
Practice Address - Phone:617-680-7669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA666101YA0400X
MA10324331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)