Healthcare Provider Details

I. General information

NPI: 1790633527
Provider Name (Legal Business Name): DOMENIC J CIAMPA MSN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 COMMONWEALTH AVE
CHESTNUT HILL MA
02467-3800
US

IV. Provider business mailing address

140 COMMONWEALTH AVE
CHESTNUT HILL MA
02467-3800
US

V. Phone/Fax

Practice location:
  • Phone: 781-521-7691
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN10009434
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN10009434
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: