Basic Information
| Provider Information | |||||||||
| NPI: | 1477059350 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NIEMIEC | ||||||||
| FirstName: | MARTHA | ||||||||
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| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | LAHEY HOSPITAL & MEDICAL CENTER | ||||||||
| Address2: | 41 MALL ROAD | ||||||||
| City: | BURLINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817448000 | ||||||||
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| Practice Location | |||||||||
| Address1: | LIFESTYLE HEALTH | ||||||||
| Address2: | 85 MIDDLESEX TPKE STE 3110 | ||||||||
| City: | BURLINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817441066 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2018 | ||||||||
| LastUpdateDate: | 09/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 103T00000X | 11465 | MA | N | Behavioral Health & Social Service Providers | Psychologist | 103TC0700X | 11465 | MA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.