Provider Demographics
NPI:1295710549
Name:AHMED, LISA RUKHSANA (MSW, LICSW)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:RUKHSANA
Last Name:AHMED
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 MAIN ST
Mailing Address - Street 2:LL2
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-2997
Mailing Address - Country:US
Mailing Address - Phone:508-660-6699
Mailing Address - Fax:
Practice Address - Street 1:841 MAIN STREET, LL2
Practice Address - Street 2:COLONY CARE BEHAVIORAL HEALTH
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081
Practice Address - Country:US
Practice Address - Phone:508-660-6699
Practice Address - Fax:508-660-6658
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10277241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP20585Medicare ID - Type UnspecifiedPROVIDER ID