Provider Demographics
NPI:1700942570
Name:GIUDICE, LISA ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANNE
Last Name:GIUDICE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:ONE BROOKLINE PL
Mailing Address - Street 2:SUITE 621
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7224
Mailing Address - Country:US
Mailing Address - Phone:781-771-8011
Mailing Address - Fax:617-734-1934
Practice Address - Street 1:ONE BROOKLINE PL
Practice Address - Street 2:SUITE 621
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7224
Practice Address - Country:US
Practice Address - Phone:781-771-8011
Practice Address - Fax:617-734-1934
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA2051372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA33663Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID