Individual
DR. LISE MARTIN
Active
Individual
DR. LISE MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6582
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1083725766
Y62170
MA
01
—
762170
MEDEX BC
MA
Enumeration date
08/31/2006
Last updated
04/22/2013
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