Provider Demographics
NPI:1669593810
Name:LIPSON, A. LISA (LIC AC)
Entity type:Individual
Prefix:
First Name:A. LISA
Middle Name:
Last Name:LIPSON
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MATHER ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-2324
Mailing Address - Country:US
Mailing Address - Phone:617-497-4881
Mailing Address - Fax:
Practice Address - Street 1:CENTRAL SQUARE ACUPUNCTURE
Practice Address - Street 2:6 BIGELOW STREET
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139
Practice Address - Country:US
Practice Address - Phone:617-497-4881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA535171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist