Healthcare Provider Details

I. General information

NPI: 1790759108
Provider Name (Legal Business Name): MELISSA MARGARET BENNETT-CARINI C. P. N. P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 BROOKLINE AVE
BOSTON MA
02115
US

IV. Provider business mailing address

162 CENTURY RD
WEYMOUTH MA
02190-3312
US

V. Phone/Fax

Practice location:
  • Phone: 617-421-2709
  • Fax:
Mailing address:
  • Phone: 781-812-2189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number237854
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: