Provider Demographics
NPI:1386798064
Name:TALUCCI, LISA (LMHC, LPC)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:TALUCCI
Suffix:
Gender:F
Credentials:LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-3625
Mailing Address - Country:US
Mailing Address - Phone:978-232-9631
Mailing Address - Fax:
Practice Address - Street 1:222 CABOT ST
Practice Address - Street 2:SUITE 1&2
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-5722
Practice Address - Country:US
Practice Address - Phone:978-921-2483
Practice Address - Fax:978-921-8483
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4042101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health