Individual
DR. LISA BLACK SOLOMON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
73 HIGH ST, CTN, CHARLESTOWN, MA 02129-3026
(617) 724-9309
(617) 726-3514
Mailing address
PO BOX 9142, CHARLESTOWN, MA 02129-9142
(617) 724-0287
(617) 726-2894
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6764
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W50647
BCBS
MA
Enumeration date
11/02/2005
Last updated
07/08/2007
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