Healthcare Provider Details

I. General information

NPI: 1972703411
Provider Name (Legal Business Name): BRIGHAM AND WOMEN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 07/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST BRIGHAM AND WOMEN'S HOSPITAL
BOSTON MA
02115-6110
US

IV. Provider business mailing address

75 FRANCIS STREET BRIGHAM AND WOMEN'S HOSPITAL
BOSTON MA
02115
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-5500
  • Fax:
Mailing address:
  • Phone: 617-732-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number213996
License Number StateMA

VIII. Authorized Official

Name: MRS. JESSICA SUZANNE LYTLE
Title or Position: CLINICAL SOCIAL WORKER
Credential: MSW, LCSW
Phone: 617-669-5662