Healthcare Provider Details

I. General information

NPI: 1063826923
Provider Name (Legal Business Name): DONNA CAWDETTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 FORDHAM RD
ALLSTON MA
02134-3006
US

IV. Provider business mailing address

14 FORDHAM RD
ALLSTON MA
02134-3006
US

V. Phone/Fax

Practice location:
  • Phone: 617-782-6460
  • Fax: 617-782-6457
Mailing address:
  • Phone: 617-782-6460
  • Fax: 617-782-6457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN199617
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: