Provider Demographics
NPI:1780916841
Name:CAHILL-GREEN, LISA (LIC AC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CAHILL-GREEN
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 WEST ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MILLBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01527-2622
Mailing Address - Country:US
Mailing Address - Phone:774-276-0568
Mailing Address - Fax:
Practice Address - Street 1:22 WEST ST
Practice Address - Street 2:SUITE 5
Practice Address - City:MILLBURY
Practice Address - State:MA
Practice Address - Zip Code:01527-2622
Practice Address - Country:US
Practice Address - Phone:774-276-0568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-31
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA243052171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist