Provider Demographics
NPI:1487809125
Name:BOSELLI, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BOSELLI
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 1:35 DEER RUN DR
Mailing Address - Street 2:
Mailing Address - City:EAST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02333-1669
Mailing Address - Country:US
Mailing Address - Phone:774-219-1632
Mailing Address - Fax:
Practice Address - Street 1:35 DEER RUN DR
Practice Address - Street 2:
Practice Address - City:EAST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02333-1669
Practice Address - Country:US
Practice Address - Phone:774-219-1632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-21
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW042741041C0700X
FLTPSW17661041C0700X
MA2144481041C0700X
MA1162991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical