Healthcare Provider Details

I. General information

NPI: 1770884744
Provider Name (Legal Business Name): ANNIE MICHELI TURF ANNIE TURF, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 11/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 BEACON ST
BROOKLINE MA
02446-4816
US

IV. Provider business mailing address

25 CHANNEL CENTER STREET UNIT 412
BOSTON MA
02210
US

V. Phone/Fax

Practice location:
  • Phone: 617-566-2200
  • Fax:
Mailing address:
  • Phone: 847-533-4519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: