Healthcare Provider Details

I. General information

NPI: 1154056471
Provider Name (Legal Business Name): CHARISSA LIN MS-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2022
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 MONTCALM AVE # 1
BRIGHTON MA
02135-2839
US

IV. Provider business mailing address

33 MONTCALM AVE # 1
BRIGHTON MA
02135-2839
US

V. Phone/Fax

Practice location:
  • Phone: 617-807-0665
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP96191
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: