Provider Demographics
NPI:1295061158
Name:TELEMACO, LIZETTE (MSW)
Entity type:Individual
Prefix:
First Name:LIZETTE
Middle Name:
Last Name:TELEMACO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 MAIN STREET
Mailing Address - Street 2:SUITE 303
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148
Mailing Address - Country:US
Mailing Address - Phone:781-324-2381
Mailing Address - Fax:781-388-1817
Practice Address - Street 1:389 MAIN ST
Practice Address - Street 2:SUITE 303
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-5017
Practice Address - Country:US
Practice Address - Phone:781-324-2381
Practice Address - Fax:781-388-1817
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker