Healthcare Provider Details

I. General information

NPI: 1437537701
Provider Name (Legal Business Name): CATHERINE BENACCHIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 05/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST ELLISON 1005
BOSTON MA
02114-2621
US

IV. Provider business mailing address

55 FRUIT ST ELLISON 1005
BOSTON MA
02114-2621
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-5025
  • Fax:
Mailing address:
  • Phone: 617-724-5025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberRN264032
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: