Individual
ALPHONSINA DISLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12 HOBSON ST, LAWRENCE, MA 01841-4940
(978) 902-7443
(978) 902-7443
Mailing address
12 HOBSON ST, LAWRENCE, MA 01841-4940
(978) 902-7443
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
MA
101YM0800X
Mental Health Counselor
—
MA
103K00000X
Behavior Analyst
Primary
—
—
103T00000X
Psychologist
—
MA
104100000X
Social Worker
—
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100026310019
—
MA
Enumeration date
05/23/2017
Last updated
05/23/2017
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