| Doctor Name: | MRS. JULIE ELLEN LYSIAK |
| NPI Number: | 1346388808 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN MS CS |
| License Number: | 210641 |
| Business Practice Address: | 148 Worcester St West Boylston, MA - 015831751 |
| Business Phone Number: | 5088351735 |
| Business Fax Number: | |
| Mailing Address: | 24 Asnebumskit Rd, PAXTON |
| State: | MA |
| Postal Code: | 016121351 |
| Phone Number: | 5087525621 |
| Fax Number: | |
| NPI Enumeration Date: | 02/04/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP0807X |
| License Number: | 210641 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Psych/Mental Health, Child & Adolescent |
| Taxonomy Definition: | |