Provider Demographics
NPI:1447347430
Name:BERNAZANI, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BERNAZANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:BERNAZANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MAC, LICAC
Mailing Address - Street 1:2285 MASS AVE, NORTH CAMBRIDGE 02140
Mailing Address - Street 2:
Mailing Address - City:NORTH CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2285 MASSACHUSETTS AVENUE
Practice Address - Street 2:#102
Practice Address - City:NORTH CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140
Practice Address - Country:US
Practice Address - Phone:339-221-3132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA691171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist