Provider Demographics
NPI:1700116266
Name:PIERCE-GOLDSTEIN, LISA (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:PIERCE-GOLDSTEIN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 LANGLEY RD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3011
Mailing Address - Country:US
Mailing Address - Phone:917-975-4799
Mailing Address - Fax:
Practice Address - Street 1:52 LANGLEY RD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3011
Practice Address - Country:US
Practice Address - Phone:917-975-4799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7851235Z00000X
NY0132231235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist