Provider Demographics
NPI:1699928978
Name:VENDETTI, LISA MARIE (LICSW)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:VENDETTI
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 LANDS END WAY
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721
Mailing Address - Country:US
Mailing Address - Phone:774-412-3306
Mailing Address - Fax:
Practice Address - Street 1:34 HAYDEN ROWE
Practice Address - Street 2:
Practice Address - City:HOPKINTON
Practice Address - State:MA
Practice Address - Zip Code:01748
Practice Address - Country:US
Practice Address - Phone:774-412-3306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-30
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1140121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical