Provider Demographics
NPI:1285756445
Name:FEDOCE, LISA M (MS)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:FEDOCE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:BOMBINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:110 BOSTON STREET
Mailing Address - Street 2:CHILDREN'S FRIEND AND FAMILY SERVICES, INC.
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-1402
Mailing Address - Country:US
Mailing Address - Phone:978-744-7903
Mailing Address - Fax:978-740-9145
Practice Address - Street 1:110 BOSTON STREET
Practice Address - Street 2:CHILDREN'S FRIEND AND FAMILY SERVICES, INC.
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-1402
Practice Address - Country:US
Practice Address - Phone:978-744-7903
Practice Address - Fax:978-740-9145
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical