| Doctor Name: | LISANDRA SAN MIGUEL |
| NPI Number: | 1003246232 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 87 Elliot St Apt 2a Springfield, MA - 011051745 |
| Business Phone Number: | 4132141644 |
| Business Fax Number: | |
| Mailing Address: | 87 Elliot St Apt 2a, SPRINGFIELD |
| State: | MA |
| Postal Code: | 011051745 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 11/25/2013 |
| NPI Last Update Date: | 11/25/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041S0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |