Provider Demographics
NPI:1205477163
Name:BOISSESU, LISA M
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:BOISSESU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37B CHESTNUT HILL RD
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:01529-1501
Mailing Address - Country:US
Mailing Address - Phone:774-214-8283
Mailing Address - Fax:
Practice Address - Street 1:32 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-1748
Practice Address - Country:US
Practice Address - Phone:508-634-3420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health