Provider Demographics
NPI:1285708693
Name:BORODKIN, LUCY ANN (LMHC)
Entity type:Individual
Prefix:MS
First Name:LUCY
Middle Name:ANN
Last Name:BORODKIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 MILTON STREET
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-3010
Mailing Address - Country:US
Mailing Address - Phone:617-776-5559
Mailing Address - Fax:617-628-1724
Practice Address - Street 1:175 ELM STREET
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144
Practice Address - Country:US
Practice Address - Phone:617-776-5559
Practice Address - Fax:617-628-1724
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALMHC608101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health