Provider Demographics
NPI:1831546324
Name:BRAYTON, LISA I (LSW)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:BRAYTON
Suffix:I
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 WATER ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-3032
Mailing Address - Country:US
Mailing Address - Phone:781-246-2003
Mailing Address - Fax:781-245-6377
Practice Address - Street 1:27 WATER ST
Practice Address - Street 2:SUITE 109
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-3032
Practice Address - Country:US
Practice Address - Phone:781-246-2003
Practice Address - Fax:781-245-6377
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA314077104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker