Healthcare Provider Details

I. General information

NPI: 1316017437
Provider Name (Legal Business Name): MARY ELLEN GALANTE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY ELLEN GALANTE IBCLC

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 09/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1493 CAMBRIDGE ST OB-GYN DEPARTMENT
CAMBRIDGE MA
02139-1047
US

IV. Provider business mailing address

1493 CAMBRIDGE ST OB-GYN DEPARTMENT
CAMBRIDGE MA
02139-1047
US

V. Phone/Fax

Practice location:
  • Phone: 617-665-1660
  • Fax:
Mailing address:
  • Phone: 617-665-1660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN193426
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number193426
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: