Provider Demographics
NPI:1699120436
Name:BARON, LISA J (EDD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:J
Last Name:BARON
Suffix:
Gender:F
Credentials:EDD
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Other - Credentials:
Mailing Address - Street 1:270 COLUMBIA RD
Mailing Address - Street 2:LILLA G. FREDERICK PILOT MIDDLE SCHOOL
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02121-3410
Mailing Address - Country:US
Mailing Address - Phone:617-849-7419
Mailing Address - Fax:617-849-7421
Practice Address - Street 1:270 COLUMBIA RD
Practice Address - Street 2:LILLA G. FREDERICK PILOT MIDDLE SCHOOL
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02121-3410
Practice Address - Country:US
Practice Address - Phone:617-849-7419
Practice Address - Fax:617-849-7421
Is Sole Proprietor?:No
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA8050103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling