Healthcare Provider Details

I. General information

NPI: 1922092683
Provider Name (Legal Business Name): JUDITH ARICK AUD CCC A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1842 BEACON ST SUITE #403
BROOKLINE MA
02445
US

IV. Provider business mailing address

1842 BEACON ST SUITE #403
BROOKLINE MA
02445
US

V. Phone/Fax

Practice location:
  • Phone: 617-232-1299
  • Fax: 617-232-7959
Mailing address:
  • Phone: 617-232-1299
  • Fax: 617-232-7959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number10
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: