Active NPI
Eliza Lundstrom Hallstrom, LMT
- Specialist
- Worcester, MA
National Provider Identifier
1962865550
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 13305
- Practice address
- 102 Shore Dr
Suite 104
Worcester, MA 01605-3154 - Phone
- (508) 853-7500
- Fax
- (508) 853-7505
- NPI assigned
- Mar 31, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 13305 | MA | Primary |
Addresses
Primary practice location
102 Shore Dr
Suite 104
Worcester, MA 01605-3154
Mailing address
102 Shore Dr
Suite 104
Worcester, MA 01605-3154
Phone (508) 853-7500
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13305 | MA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1459382400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1459382400000",
"number": "1962865550",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "102 SHORE DR",
"address_2": "SUITE 104",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016053154",
"telephone_number": "508-853-7500",
"fax_number": "508-853-7505"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "102 SHORE DR",
"address_2": "SUITE 104",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016053154",
"telephone_number": "508-853-7500",
"fax_number": "508-853-7505"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUNDSTROM HALLSTROM",
"first_name": "ELIZA",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-03-31",
"last_updated": "2016-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "MA",
"license": "13305",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Worcester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.