Provider Demographics
NPI:1326391335
Name:PYENSON, LISA MICHELLE
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELLE
Last Name:PYENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 MAIN STREET
Mailing Address - Street 2:SUITE 450
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-752-2590
Mailing Address - Fax:508-753-5051
Practice Address - Street 1:42 SUMMER ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4624
Practice Address - Country:US
Practice Address - Phone:413-442-0402
Practice Address - Fax:508-753-5051
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA22220002001OtherBLUE CROSS BLUE SHEILD
MA1306461Medicaid
MAM18684OtherBLUE CROSS OF MASS
MA1308785Medicaid
MA1306461Medicaid