Provider Demographics
NPI:1750932885
Name:LAGAMBINA, ALYSIA
Entity type:Individual
Prefix:
First Name:ALYSIA
Middle Name:
Last Name:LAGAMBINA
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 1:364 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-6157
Mailing Address - Country:US
Mailing Address - Phone:781-526-0260
Mailing Address - Fax:
Practice Address - Street 1:364 MAIN ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-6157
Practice Address - Country:US
Practice Address - Phone:781-526-0260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker