Individual
LISA SMALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5 FLORENCE AVE, TEWKSBURY, MA 01876-4413
(978) 804-7288
Mailing address
5 FLORENCE AVE, TEWKSBURY, MA 01876-4413
(978) 804-7288
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100203592439
—
MA
Enumeration date
05/13/2019
Last updated
06/08/2022
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