Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 3003 | MA |
N | 103T00000X | Psychologist | 3003 | MA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 3003 | MA |
N | 103TA0700X | Adult Development & Aging Psychologist | 3003 | MA |
Y | 103G00000X | Clinical Psychologist | 3003 | MA |
Y | 103TC0700X | Clinical Psychologist | 3003 | MA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 3003 | MA |
N | 103TF0000X | Family Psychologist | 3003 | MA |
N | 103TF0200X | Forensic Psychologist | 3003 | MA |
NPI | 1538220751 |
---|---|
Provider Name | Dr. Lisa A Krock |
First Address | Westwood, MA 02090-2831 |
Second Address | Hanover, MA 02339-2226 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 07/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0510629 | (05) | MA |