Healthcare Provider Details

I. General information

NPI: 1467959163
Provider Name (Legal Business Name): BOSTON LACTATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 MARY ST
ARLINGTON MA
02474-8847
US

IV. Provider business mailing address

143 MARY ST
ARLINGTON MA
02474-8847
US

V. Phone/Fax

Practice location:
  • Phone: 781-632-7239
  • Fax:
Mailing address:
  • Phone: 781-632-7239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number10873023
License Number StateMA

VIII. Authorized Official

Name: MS. HEATHER BINGHAM
Title or Position: OWNER
Credential: IBCLC
Phone: 781-632-7239