Provider Demographics
NPI:1104264589
Name:MICHAUD, LISA LEE (MA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:LEE
Last Name:MICHAUD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SHORE DR
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-2030
Mailing Address - Country:US
Mailing Address - Phone:978-726-1161
Mailing Address - Fax:
Practice Address - Street 1:50 HOWE AVE
Practice Address - Street 2:
Practice Address - City:MILLBURY
Practice Address - State:MA
Practice Address - Zip Code:01527-3264
Practice Address - Country:US
Practice Address - Phone:508-865-2085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-07
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health