Provider Demographics
NPI:1770618290
Name:ELWELL, LISA MARIE (BC-HIS)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:ELWELL
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:CARNEVALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BC-HIS
Mailing Address - Street 1:50 AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-2318
Mailing Address - Country:US
Mailing Address - Phone:617-232-1299
Mailing Address - Fax:617-232-7959
Practice Address - Street 1:990 PARADISE RD
Practice Address - Street 2:SUITE #1G
Practice Address - City:SWAMPSCOTT
Practice Address - State:MA
Practice Address - Zip Code:01907-1395
Practice Address - Country:US
Practice Address - Phone:781-581-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA87237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110029042AMedicaid