Provider Demographics
NPI:1679393136
Name:PANICO, LILA ELENA
Entity type:Individual
Prefix:
First Name:LILA
Middle Name:ELENA
Last Name:PANICO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 440436
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-0006
Mailing Address - Country:US
Mailing Address - Phone:617-623-6111
Mailing Address - Fax:617-616-5084
Practice Address - Street 1:255 ELM ST STE 204
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2947
Practice Address - Country:US
Practice Address - Phone:617-623-6111
Practice Address - Fax:617-616-5084
Is Sole Proprietor?:No
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator