Provider Demographics
NPI:1124102496
Name:LIOTTA, MEASUE PARK (LCSW)
Entity type:Individual
Prefix:MS
First Name:MEASUE
Middle Name:PARK
Last Name:LIOTTA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 OLD SOUTH LN
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-3908
Mailing Address - Country:US
Mailing Address - Phone:978-475-3035
Mailing Address - Fax:
Practice Address - Street 1:11 UNION ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1815
Practice Address - Country:US
Practice Address - Phone:978-685-1337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2122531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical