Healthcare Provider Details

I. General information

NPI: 1659701191
Provider Name (Legal Business Name): BOSTON PAIN RELIEF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2013
Last Update Date: 11/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 SUMMER ST
BOSTON MA
02110-1225
US

IV. Provider business mailing address

23 KINGS VIEW RD
MARLBOROUGH MA
01752-1547
US

V. Phone/Fax

Practice location:
  • Phone: 508-330-6448
  • Fax:
Mailing address:
  • Phone: 508-330-6448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberLMT 9145
License Number StateMA

VIII. Authorized Official

Name: MS. LUCY LU ALLEN
Title or Position: MANAGER
Credential: LMT
Phone: 508-330-6448